Provider Demographics
NPI:1841350758
Name:STEPHEN M GOLLOMP MD PC
Entity type:Organization
Organization Name:STEPHEN M GOLLOMP MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GOLLOMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-642-5371
Mailing Address - Street 1:SUITE 161, LANKENAU MEDICAL BLDG EAST
Mailing Address - Street 2:100 EAST LANCASTER AVENUE
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3425
Mailing Address - Country:US
Mailing Address - Phone:610-642-5371
Mailing Address - Fax:610-642-5658
Practice Address - Street 1:SUITE 161, LANKENAU MEDICAL BLDG EAST
Practice Address - Street 2:100 EAST LANCASTER AVENUE
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3425
Practice Address - Country:US
Practice Address - Phone:610-642-5371
Practice Address - Fax:610-642-5658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2018-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024887E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty