Organization
MAINLINE HEALTH ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMMED KIDWAI M.D. (M.D.)
(610) 667-1115
Entity
Organization
Contact information
Practice address
2 BALA PLZ, IL-50, BALA CYNWYD, PA 19004-1501
(610) 667-1115
Mailing address
2 BALA PLZ, IL-50, BALA CYNWYD, PA 19004-1501
(610) 667-1115
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
MD 433668
PA
261QF0050X
Non-Surgical Family Planning Clinic/Center
MD 433668
PA
261QH0100X
Health Service Clinic/Center
MD 433668
PA
261QP2300X
Primary Care Clinic/Center
MD 433668
PA
Other
Enumeration date
03/04/2013
Last updated
03/04/2013
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