Provider Demographics
NPI:1952349623
Name:BEAVER VALLEY UROLOGY
Entity Type:Organization
Organization Name:BEAVER VALLEY UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRICE
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-775-6446
Mailing Address - Street 1:1700 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-1715
Mailing Address - Country:US
Mailing Address - Phone:724-775-6446
Mailing Address - Fax:724-775-4856
Practice Address - Street 1:1700 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-1715
Practice Address - Country:US
Practice Address - Phone:724-775-6446
Practice Address - Fax:724-775-4856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019128E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA110715Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER