Provider Demographics
NPI:1851644942
Name:LOSE WEIGHT 1 LLC
Entity Type:Organization
Organization Name:LOSE WEIGHT 1 LLC
Other - Org Name:MEDI-WEIGHTLOSS CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-251-2525
Mailing Address - Street 1:901 LANCASTER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1710
Mailing Address - Country:US
Mailing Address - Phone:610-251-2525
Mailing Address - Fax:610-251-2599
Practice Address - Street 1:901 LANCASTER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1710
Practice Address - Country:US
Practice Address - Phone:610-251-2525
Practice Address - Fax:610-251-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty