Provider Demographics
NPI:1720277965
Name:PENNSYLVANIA SURGICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PENNSYLVANIA SURGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-829-7495
Mailing Address - Street 1:301 S 8TH ST
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4000
Mailing Address - Country:US
Mailing Address - Phone:215-829-8455
Mailing Address - Fax:215-829-8454
Practice Address - Street 1:301 S 8TH ST
Practice Address - Street 2:SUITE 4A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4000
Practice Address - Country:US
Practice Address - Phone:215-829-8455
Practice Address - Fax:215-829-8454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010352E174400000X
PAMD037959E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC32118Medicare UPIN