Provider Demographics
NPI:1942368196
Name:J FREDERICK LAUCIUS MD LEWIS J ROSE MD ANDREW E CHAPMAN DO ET AL
Entity Type:Organization
Organization Name:J FREDERICK LAUCIUS MD LEWIS J ROSE MD ANDREW E CHAPMAN DO ET AL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DALESSIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-238-1139
Mailing Address - Street 1:1015 CHESTNUT ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4316
Mailing Address - Country:US
Mailing Address - Phone:215-238-1139
Mailing Address - Fax:215-574-1492
Practice Address - Street 1:1015 CHESTNUT ST
Practice Address - Street 2:SUITE 1321
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4316
Practice Address - Country:US
Practice Address - Phone:215-238-1139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000026192OtherHIGHMARK BLUE SHIELD
0061424000OtherKEYSTONE PC
0061424000OtherKEYSTONE PC
PA026192Medicare PIN