Organization
DELAWARE VALLEY I.D. ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA CAVALLARO (DIRECTOR OF FINANCE AND OPERATIONS)
(610) 896-0210
Entity
Organization
Contact information
Practice address
100 E LANCASTER AVE, MOB EAST 556, WYNNEWOOD, PA 19096-3450
(610) 896-0210
(610) 896-5101
Mailing address
100 E LANCASTER AVE, MOB EAST 556, WYNNEWOOD, PA 19096-3450
(610) 896-0210
(610) 896-5101
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0061398000
KEYSTONE HEALTH PLAN EAST
PA
05
—
01886952
—
PA
01
—
097746
INDEPENDENCE BLUE CROSS
PA
01
—
54910
AETNA
PA
Enumeration date
07/27/2006
Last updated
01/22/2020
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