Organization
MAIN LINE EMERGENCY MED ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN J GAMBURG MD (PRESIDENT)
(800) 456-4629
Entity
Organization
Contact information
Practice address
255 W LANCASTER AVE, PAOLI, PA 19301-1763
(610) 648-1043
(610) 648-1415
Mailing address
PO BOX 415751, BOSTON, MA 02241-5751
(866) 960-6774
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001019000
IBC
PA
01
—
0001101000
IBC
PA
01
—
0001107000
IBC
PA
05
—
0016139730024
—
PA
05
—
0016139730025
—
PA
05
—
0016139730026
—
PA
01
—
1043495
KEYSTONE MERCY
PA
01
—
173870000
KEYSTONE HEALTH EAST
PA
01
—
191510
PERSONAL CHOICE
PA
01
—
20020291
AMERIHEALTH MERCY
PA
Enumeration date
02/03/2006
Last updated
11/15/2010
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