Provider Demographics
NPI:1619972965
Name:UROLOGIC SURGERY, PC
Entity Type:Organization
Organization Name:UROLOGIC SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-667-3021
Mailing Address - Street 1:301 E CITY AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1734
Mailing Address - Country:US
Mailing Address - Phone:610-667-3020
Mailing Address - Fax:610-667-1817
Practice Address - Street 1:301 E CITY AVE
Practice Address - Street 2:STE 210
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1734
Practice Address - Country:US
Practice Address - Phone:610-667-3020
Practice Address - Fax:610-667-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003582L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011960660005Medicaid
PA602286Medicare ID - Type Unspecified