Provider Demographics
NPI:1790742187
Name:MAIN LINE SURGEONS, LTD.
Entity Type:Organization
Organization Name:MAIN LINE SURGEONS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPLETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN MPH
Authorized Official - Phone:610-642-1908
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:MEDICAL SCIENCE BLDG. SUITE 275
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-642-1908
Mailing Address - Fax:
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:MEDICAL SCIENCE BLDG. SUITE 275
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-642-1908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB36854Medicare UPIN
PAH39570Medicare UPIN
PAE13063Medicare UPIN
PAB41050Medicare UPIN
PAI08688Medicare UPIN
PAG38335Medicare UPIN
PAB36586Medicare UPIN
PA641190Medicare ID - Type UnspecifiedGROUP NUMBER
PAE85187Medicare UPIN