Organization
SOUTHEASTERN PENNSYLVANIA UROLOGIC SURGERY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL CHIUSANO M.D. (OWNER)
(610) 869-6851
Entity
Organization
Contact information
Practice address
1011 W BALTIMORE PIKE, STE 312, WEST GROVE, PA 19390-9446
(510) 869-6851
Mailing address
1011 W BALTIMORE PIKE, STE 312, WEST GROVE, PA 19390-9446
(510) 869-6851
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015965780009
—
PA
01
—
1039444
MERCY HEALTH PLAN
PA
01
—
1378803
PA BLUE SHIELD
PA
01
—
2070420000
KEYSTONE HPE
PA
01
—
340019880
RAIL ROAD MEDICARE
PA
01
—
P484619
OXFORD
PA
Enumeration date
11/05/2007
Last updated
12/07/2010
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