Provider Demographics
NPI:1619958048
Name:HATBORO MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:HATBORO MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-675-1516
Mailing Address - Street 1:345 N YORK RD
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-2045
Mailing Address - Country:US
Mailing Address - Phone:215-675-1516
Mailing Address - Fax:215-675-0901
Practice Address - Street 1:345 N YORK RD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-2045
Practice Address - Country:US
Practice Address - Phone:215-675-1516
Practice Address - Fax:215-675-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000694672-0002Medicaid
PA000694672-0002Medicaid