Provider Demographics
NPI:1902192917
Name:SEASONS OF LIFE OBSTETRICS AND GYNECOLOGY, PC
Entity Type:Organization
Organization Name:SEASONS OF LIFE OBSTETRICS AND GYNECOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PEARL
Authorized Official - Last Name:GREISS-COULT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:484-553-6276
Mailing Address - Street 1:6553 HOFFMAN LN
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-3030
Mailing Address - Country:US
Mailing Address - Phone:484-553-6276
Mailing Address - Fax:
Practice Address - Street 1:1611 POND RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2258
Practice Address - Country:US
Practice Address - Phone:610-366-7000
Practice Address - Fax:610-366-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012199207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3840818000OtherINDEPENDENCE BLUE CROSS
PA2634499OtherHIGHMARK BLUE SHIELD
PA4152777OtherCIGNA
PA50101952OtherCAPITAL BLUE CROSS
PA26895627OtherUNITED HEALTHCARE