Organization
OBSTETRICS & GYNECOLOGY FUND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN JERVIS (ADMINISTRATOR)
(610) 645-2325
Entity
Organization
Contact information
Practice address
100 E LANCASTER AVE, WYNNEWOOD, PA 19096-3450
(610) 645-8090
(610) 645-2422
Mailing address
100 E LANCASTER AVE, SUITE 301, WYNNEWOOD, PA 19096-3450
(610) 645-8090
(610) 645-2422
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006867230002
—
PA
Enumeration date
03/15/2007
Last updated
08/22/2020
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