Provider Demographics
NPI:1689020026
Name:TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
Entity Type:Organization
Organization Name:TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
Other - Org Name:ST. MARY FAMILY PRACTICE - MIDDLETOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:PROFERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-710-2013
Mailing Address - Street 1:41 UNIVERSITY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-710-5522
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:4595 NEW FALLS RD
Practice Address - Street 2:SUITE A
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056
Practice Address - Country:US
Practice Address - Phone:267-587-3700
Practice Address - Fax:215-949-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty