Provider Demographics
NPI:1801047535
Name:DONALD J COREY
Entity type:Organization
Organization Name:DONALD J COREY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:COREY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:610-649-4692
Mailing Address - Street 1:100 EAST LANCASTER AVE
Mailing Address - Street 2:SUITE 161 MEDICAL OFFICE BUILDING EAST
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096
Mailing Address - Country:US
Mailing Address - Phone:610-649-4692
Mailing Address - Fax:
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:SUITE 161 MEDICAL OFFICE BUILDING EAST
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-649-4692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016795E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA120344Medicare PIN
155911Medicare PIN