Provider Demographics
NPI:1245451426
Name:POTTSTOWN MEDICAL SPECIALISTS, INC.
Entity type:Organization
Organization Name:POTTSTOWN MEDICAL SPECIALISTS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMMUNICATIONS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-327-4200
Mailing Address - Street 1:1591 MEDICAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464
Mailing Address - Country:US
Mailing Address - Phone:610-326-8005
Mailing Address - Fax:610-327-9629
Practice Address - Street 1:1591 MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464
Practice Address - Country:US
Practice Address - Phone:610-326-8005
Practice Address - Fax:610-327-9629
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POTTSTOWN MEDICAL SPECIALISTS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-02
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD023984E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0045725010OtherKEYSTONE GROUP NUMBER