Provider Demographics
NPI:1689612277
Name:LA NOCE MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:LA NOCE MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:LA NOCE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-483-8666
Mailing Address - Street 1:446 DOMINO LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-4302
Mailing Address - Country:US
Mailing Address - Phone:215-483-8666
Mailing Address - Fax:215-483-9616
Practice Address - Street 1:446 DOMINO LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-4302
Practice Address - Country:US
Practice Address - Phone:215-483-8666
Practice Address - Fax:215-483-9616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
586952Medicare ID - Type Unspecified