Provider Demographics
NPI:1952415010
Name:MAUREEN C. PERSIN DO PC
Entity type:Organization
Organization Name:MAUREEN C. PERSIN DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT, CCS-P, CAHIMS
Authorized Official - Phone:610-866-0466
Mailing Address - Street 1:217 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5517
Mailing Address - Country:US
Mailing Address - Phone:610-866-0466
Mailing Address - Fax:610-866-1405
Practice Address - Street 1:217 W BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5517
Practice Address - Country:US
Practice Address - Phone:610-866-0466
Practice Address - Fax:610-866-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008314L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA068917Medicare ID - Type Unspecified
PAG28044Medicare UPIN