Organization
MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA
Active
Other names
Mercy Fitzgerald Surgical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS C SMITH (CFO)
(610) 567-6964
Entity
Organization
Contact information
Practice address
1501 LANSDOWNE AVE, SUITE 305, DARBY, PA 19023-1333
(610) 534-6170
(610) 534-6159
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
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007787930153
—
PA
01
—
1738463
BLUE SHIELD
PA
01
—
2414129000
KHPE
PA
01
—
30023892
KEYSTONE MECY
PA
01
—
3955657
AETNA
PA
01
—
5746424
CIGNA
PA
01
—
DA5351
RAILROAD MEDICARE
PA
Enumeration date
11/15/2005
Last updated
11/05/2009
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