Provider Demographics
NPI:1912202250
Name:VISITING PHYSICIANS OF THE DELAWARE VALLEY LLC
Entity Type:Organization
Organization Name:VISITING PHYSICIANS OF THE DELAWARE VALLEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-364-8412
Mailing Address - Street 1:3070 BRISTOL PIKE STE 2-216
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5361
Mailing Address - Country:US
Mailing Address - Phone:215-364-8412
Mailing Address - Fax:215-364-8730
Practice Address - Street 1:3070 BRISTOL PIKE STE 2-216
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-5361
Practice Address - Country:US
Practice Address - Phone:215-364-8412
Practice Address - Fax:215-364-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAPPLIED FORMedicare PIN