Provider Demographics
NPI:1205932761
Name:WHITEMARSH MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:WHITEMARSH MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:G
Authorized Official - Last Name:REEKIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-440-2050
Mailing Address - Street 1:1107 BETHLEHEM PIKE STE 210
Mailing Address - Street 2:
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-1919
Mailing Address - Country:US
Mailing Address - Phone:267-440-2050
Mailing Address - Fax:267-440-2060
Practice Address - Street 1:1107 BETHLEHEM PIKE STE 210
Practice Address - Street 2:
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1919
Practice Address - Country:US
Practice Address - Phone:267-440-2050
Practice Address - Fax:267-440-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022417E207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC28631Medicare UPIN
PA088219Medicare ID - Type Unspecified