Organization
WESTERN MAIN LINE UROLOGY PC
Active
Organization
WESTERN MAIN LINE UROLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY M THOMPSON MD (OWNER)
(610) 644-9600
Entity
Organization
Contact information
Practice address
255 W LANCASTER AVE, SUITE 333, PAOLI, PA 19301-1763
(610) 644-9600
(610) 644-0804
Mailing address
255 W LANCASTER AVE, SUITE 333, PAOLI, PA 19301-1763
(610) 644-9600
(610) 644-0804
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD04339E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011574150003
—
PA
01
—
0866534000
IBC
PA
01
—
920504
HIGHMARK BS
PA
Enumeration date
03/19/2007
Last updated
08/31/2010
Update your record
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