Provider Demographics
NPI:1942218136
Name:KNIGHTS ROAD MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:KNIGHTS ROAD MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMALLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-638-8500
Mailing Address - Street 1:2846 KNIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-3552
Mailing Address - Country:US
Mailing Address - Phone:215-638-8500
Mailing Address - Fax:215-638-0413
Practice Address - Street 1:2846 KNIGHTS RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3552
Practice Address - Country:US
Practice Address - Phone:215-638-8500
Practice Address - Fax:215-638-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045798L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty