Provider Demographics
NPI:1760198824
Name:INTEGRACE, INC.
Entity Type:Organization
Organization Name:INTEGRACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP, CFO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-661-8330
Mailing Address - Street 1:420 DELAWARE DR
Mailing Address - Street 2:
Mailing Address - City:FT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2711
Mailing Address - Country:US
Mailing Address - Phone:267-787-4097
Mailing Address - Fax:
Practice Address - Street 1:501 E CAMPUS AVE
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1696
Practice Address - Country:US
Practice Address - Phone:267-787-4097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRACE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty