Organization
UROLOGIC CONSULTANTS OF SOUTHEASTERN PENNSYLVANIA, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY P MILLER (PRACTICE MANAGER)
(610) 667-3020
Entity
Organization
Contact information
Practice address
1 PRESIDENTIAL BLVD, STE 100, BALA CYNWYD, PA 19004-1017
(610) 667-3020
(610) 667-1817
Mailing address
1 PRESIDENTIAL BLVD, STE 100, BALA CYNWYD, PA 19004-1017
(610) 667-3020
(610) 667-1817
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1018621670001
—
PA
01
—
110709
MEDICARE GROUP PTAN
PA
01
—
16408
CIGNA-HEALTHSPRING
PA
01
—
1930192
BLUE SHIELD
PA
01
—
2800927000
INDEPENDENCE BLUE CROSS
PA
01
—
DF9637
RAILROAD MEDICARE PTAN
PA
Enumeration date
06/13/2011
Last updated
09/18/2014
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