Provider Demographics
NPI:1013016716
Name:DELAWARE VALLEY MEDICAL SPECIALTIES
Entity Type:Organization
Organization Name:DELAWARE VALLEY MEDICAL SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRANON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-877-1100
Mailing Address - Street 1:1100 N 63RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-3208
Mailing Address - Country:US
Mailing Address - Phone:215-877-1100
Mailing Address - Fax:215-877-3710
Practice Address - Street 1:1100 N 63RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-3208
Practice Address - Country:US
Practice Address - Phone:215-877-1100
Practice Address - Fax:215-877-3710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006821-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA041165Medicare ID - Type Unspecified