Provider Demographics
NPI:1720025109
Name:PENN DEL MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:PENN DEL MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:TEANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-485-1176
Mailing Address - Street 1:1541 CHICHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4207
Mailing Address - Country:US
Mailing Address - Phone:610-485-1176
Mailing Address - Fax:610-485-6780
Practice Address - Street 1:1541 CHICHESTER AVE
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:PA
Practice Address - Zip Code:19061-4207
Practice Address - Country:US
Practice Address - Phone:610-485-1176
Practice Address - Fax:610-485-6780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035620E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012497870004Medicaid
PA070118Medicare PIN