Provider Demographics
NPI:1750336970
Name:NORTHWEST INTERNAL MEDICINE
Entity type:Organization
Organization Name:NORTHWEST INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-836-5100
Mailing Address - Street 1:8200 FLOURTOWN AVE
Mailing Address - Street 2:SUITE7
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-7976
Mailing Address - Country:US
Mailing Address - Phone:215-836-5100
Mailing Address - Fax:215-836-6011
Practice Address - Street 1:8200 FLOURTOWN AVE
Practice Address - Street 2:SUITE7
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-7976
Practice Address - Country:US
Practice Address - Phone:215-836-5100
Practice Address - Fax:215-836-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA015879Medicare ID - Type Unspecified