Provider Demographics
NPI:1922462670
Name:LANSDALE HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:LANSDALE HOSPITAL CORPORATION
Other - Org Name:LANSDALE NUTRITIONISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-481-2850
Mailing Address - Street 1:100 MEDICAL CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1259
Mailing Address - Country:US
Mailing Address - Phone:215-361-4996
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL CAMPUS DR
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1259
Practice Address - Country:US
Practice Address - Phone:215-361-4996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty