Organization
NAZARETH PHYSICIAN SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANCE CASTLE (SIR DIR PHYSICIAN BILLING)
(610) 567-5520
Entity
Organization
Contact information
Practice address
2701 HOLME AVE, SUITE 205, PHILADELPHIA, PA 19152-2029
(215) 543-1026
(215) 338-1250
Mailing address
1 W ELM ST, SUITE 100, CONSHOHOCKEN, PA 19428-2007
(610) 567-6967
(610) 567-6170
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
—
—
207VG0400X
Gynecology Physician
—
—
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1014655140002
—
PA
01
—
2457876000
IBC#
PA
01
—
425807
AETNA OFFICE #
PA
01
—
NA1775677
HIGHMARK BLUE SHIELD
PA
Enumeration date
05/12/2006
Last updated
12/07/2016
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