Provider Demographics
NPI:1750361978
Name:MAIN LINE ORTHOPAEDICS PC
Entity type:Organization
Organization Name:MAIN LINE ORTHOPAEDICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:V
Authorized Official - Last Name:VERNACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-527-9500
Mailing Address - Street 1:101 S BRYN MAWR AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3120
Mailing Address - Country:US
Mailing Address - Phone:610-527-9500
Mailing Address - Fax:610-527-9529
Practice Address - Street 1:101 S BRYN MAWR AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3120
Practice Address - Country:US
Practice Address - Phone:610-527-9500
Practice Address - Fax:610-527-9529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACN2718OtherTRAVELERS MEDICARE
815911OtherHIGHMARK BS
815911OtherHIGHMARK BS
PA815911Medicare PIN