# ACADEMIC UROLOGY OF PA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336439645
- **Authorized official:** DR. DAVID J ELLIS M.D. (PRESIDENT)
- **Authorized official phone:** (610) 382-5910

## Contact information

- **Practice address:** 919 CONESTOGA RD, BUILDING 1 SUITE 300, BRYN MAWR, PA 19010-1352
- **Practice address phone:** (610) 525-6580
- **Practice address fax:** (610) 525-3664
- **Mailing address:** 211 S GULPH RD, SUITE 200, KING OF PRUSSIA, PA 19406-3112
- **Mailing address phone:** (610) 382-5910
- **Mailing address fax:** (610) 382-5918

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 50421501 | PA | Yes |

## Other

- **Enumeration date:** 04/08/2011
- **Last updated:** 04/03/2024