Provider Demographics
NPI:1336209980
Name:PRIME, MICHAEL F (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:PRIME
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3855 W CHESTER PIKE STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2304
Mailing Address - Country:US
Mailing Address - Phone:484-427-8000
Mailing Address - Fax:484-427-8020
Practice Address - Street 1:3855 W CHESTER PIKE STE 300
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073
Practice Address - Country:US
Practice Address - Phone:484-427-8000
Practice Address - Fax:484-427-8020
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007913L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001399210Medicaid
PA001399210Medicaid
PAF51886Medicare UPIN