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Organization
MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANI
Active
Organization
MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANI
Active
Other names
MMS-Mercy Fitzgerald Hospialist
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS C SMITH (VP FINANCIAL SERVICES)
(610) 567-6964
Entity
Organization
Contact information
Practice address
1500 LANSDOWNE AVE, DARBY, PA 19023-1200
(610) 237-3698
(610) 237-2580
Mailing address
1 W ELM ST, 2ND FLOOR, CONSHOHOCKEN, PA 19428-2007
(610) 567-6964
(610) 567-6170
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007787930151
—
PA
01
—
1549250
BLUE SHIELD
PA
01
—
2233321000
KEYSTONE HEALTH PLAN EAST
PA
01
—
2341239
AETNA HMO
PA
01
—
30011099
KEYSTONE MERCY HEALTH PLA
PA
01
—
7202146
AETNA PPO
PA
Enumeration date
12/20/2005
Last updated
03/11/2008
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