Provider Demographics
NPI:1932271442
Name:MCH UROLOGIC ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:MCH UROLOGIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MALLOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-829-3409
Mailing Address - Street 1:299 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4010
Mailing Address - Country:US
Mailing Address - Phone:215-829-3409
Mailing Address - Fax:215-925-9749
Practice Address - Street 1:299 S 8TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4010
Practice Address - Country:US
Practice Address - Phone:215-829-3409
Practice Address - Fax:215-925-9749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5900OtherAETNA GROUP
2256686000OtherKEYSTONE