Provider Demographics
NPI:1740784123
Name:VIA AFFILIATES
Entity Type:Organization
Organization Name:VIA AFFILIATES
Other - Org Name:DOYLESTOWN HEALTH WOUND CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-345-2389
Mailing Address - Street 1:PO BOX 829641
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0001
Mailing Address - Country:US
Mailing Address - Phone:267-370-5296
Mailing Address - Fax:215-230-3725
Practice Address - Street 1:595 W STATE ST
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2554
Practice Address - Country:US
Practice Address - Phone:267-370-5296
Practice Address - Fax:267-885-1757
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIA AFFILIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-21
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty