Provider Demographics
NPI:1841383635
Name:MAIN LINE LIPID ASSOCIATES
Entity Type:Organization
Organization Name:MAIN LINE LIPID ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-649-6515
Mailing Address - Street 1:100 E. LANCASTER AVENUE
Mailing Address - Street 2:SUITE 356
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096
Mailing Address - Country:US
Mailing Address - Phone:610-649-6515
Mailing Address - Fax:610-649-6516
Practice Address - Street 1:100 E. LANCASTER AVENUE
Practice Address - Street 2:SUITE 356
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:610-649-6515
Practice Address - Fax:610-649-6516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty