Provider Demographics
NPI:1952829350
Name:CENTERS FOR ADVANCED UROLOGY, LLP
Entity Type:Organization
Organization Name:CENTERS FOR ADVANCED UROLOGY, LLP
Other - Org Name:MIDLANTIC UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-530-0205
Mailing Address - Street 1:140 W GERMANTOWN PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1421
Mailing Address - Country:US
Mailing Address - Phone:484-530-0205
Mailing Address - Fax:484-530-0209
Practice Address - Street 1:140 W GERMANTOWN PIKE STE 250
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1421
Practice Address - Country:US
Practice Address - Phone:484-530-0205
Practice Address - Fax:484-530-0209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty