Provider Demographics
NPI:1780033845
Name:MONTGOMERY COUNTY HAND CENTER
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY HAND CENTER
Other - Org Name:THE UPPER EXTREMITY INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUGAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-277-1990
Mailing Address - Street 1:1515 DEKALB PIKE STE 204
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-3367
Mailing Address - Country:US
Mailing Address - Phone:610-277-1990
Mailing Address - Fax:610-277-2007
Practice Address - Street 1:1515 DEKALB PIKE STE 204
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-3367
Practice Address - Country:US
Practice Address - Phone:610-277-1990
Practice Address - Fax:610-277-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207XS0106X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA180067Medicare PIN
PA0410430001Medicare PIN