Provider Demographics
NPI:1891875456
Name:BUXMONT MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:BUXMONT MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-918-5555
Mailing Address - Street 1:847 EASTON RD
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-2907
Mailing Address - Country:US
Mailing Address - Phone:215-918-5555
Mailing Address - Fax:215-918-5560
Practice Address - Street 1:847 EASTON RD
Practice Address - Street 2:SUITE 2500
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-2907
Practice Address - Country:US
Practice Address - Phone:215-918-5555
Practice Address - Fax:215-918-5560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA139172OtherAETNA GROUP ID NUMBER
PA1462206OtherHIGHMARK BLUE SHIELD #
PA2151562001OtherKEYSTONE HEALTHPLAN GROUP
PA139172OtherAETNA GROUP ID NUMBER