Provider Demographics
NPI:1851636591
Name:MAIN LINE HEALTH
Entity Type:Organization
Organization Name:MAIN LINE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHS
Authorized Official - Phone:484-565-1130
Mailing Address - Street 1:479 PILGRIM LA
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 PILGRIM LN
Practice Address - Street 2:SUITE 103
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-5000
Practice Address - Country:US
Practice Address - Phone:484-476-6543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital