Provider Demographics
NPI:1851694772
Name:FIELDHOUSE WELLNESS, PC
Entity Type:Organization
Organization Name:FIELDHOUSE WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-981-6400
Mailing Address - Street 1:255 GREAT VALLEY PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1300
Mailing Address - Country:US
Mailing Address - Phone:610-981-6400
Mailing Address - Fax:610-981-6702
Practice Address - Street 1:255 GREAT VALLEY PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1300
Practice Address - Country:US
Practice Address - Phone:610-981-6400
Practice Address - Fax:610-981-6702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006167L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEF86243Medicare UPIN