Provider Demographics
NPI:1679843288
Name:TOWER HEALTH MEDICAL GROUP
Entity Type:Organization
Organization Name:TOWER HEALTH MEDICAL GROUP
Other - Org Name:NEONATOLOGY OUTPATIENT WEST READING TOWER HEALTH MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-628-8181
Mailing Address - Street 1:PO BOX 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:484-628-0799
Mailing Address - Fax:
Practice Address - Street 1:301 S 7TH AVE
Practice Address - Street 2:STE 3120
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1410
Practice Address - Country:US
Practice Address - Phone:484-628-8843
Practice Address - Fax:484-628-8348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA072790Medicare PIN