Provider Demographics
NPI:1639293046
Name:STOWE MEDICAL GROUP
Entity Type:Organization
Organization Name:STOWE MEDICAL GROUP
Other - Org Name:STOWE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMMUNICATIONS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-327-4200
Mailing Address - Street 1:555 GLASGOW ST
Mailing Address - Street 2:
Mailing Address - City:STOWE
Mailing Address - State:PA
Mailing Address - Zip Code:19464-6557
Mailing Address - Country:US
Mailing Address - Phone:484-945-0770
Mailing Address - Fax:
Practice Address - Street 1:1610 MEDICAL DR
Practice Address - Street 2:SUITE 310
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3292
Practice Address - Country:US
Practice Address - Phone:610-327-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STOWE MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012002207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0045725004OtherKEYSTONE HMO
PA26191OtherBLUE SHIELD ASSIGN.ACCT
PA0045725004OtherKEYSTONE HMO