Provider Demographics
NPI:1255439683
Name:WARD, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:WARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 WOODVIEW RD STE 210
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9301
Mailing Address - Country:US
Mailing Address - Phone:610-345-0977
Mailing Address - Fax:610-902-6081
Practice Address - Street 1:455 WOODVIEW RD STE 210
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9301
Practice Address - Country:US
Practice Address - Phone:610-345-0977
Practice Address - Fax:610-345-0986
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067134L207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3222093OtherCIGNA
PA5840646OtherAETNA
PA0645363000OtherKEYSTONE HEALTH PLAN EAST
PA000038709OtherINDEPENDENCE BLUE CROSS
PAG83666Medicare UPIN
PA5840646OtherAETNA
PA3222093OtherCIGNA