Organization
MAIN LINE MEDICAL EXERCISE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROGER SCHWAB (PRESIDENT)
(610) 527-7870
Entity
Organization
Contact information
Practice address
931 E HAVERFORD RD, BRYN MAWR, PA 19010-3838
(610) 527-7870
(610) 527-2337
Mailing address
931 E HAVERFORD RD, BRYN MAWR, PA 19010-3838
(610) 527-7870
(610) 527-2337
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0506820000
PERSONAL CHOICE
PA
01
—
4479578
AETNA
PA
01
—
450716
AETNA HMO
PA
01
—
655497
HIGHMARK BLUE SHIELD
PA
Enumeration date
08/01/2006
Last updated
07/30/2012
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