Organization
MCH UROLOGIC ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRENCE R MALLOY M.D. (PRESIDENT)
(215) 829-3409
Entity
Organization
Contact information
Practice address
299 S 8TH ST, PHILADELPHIA, PA 19106-4010
(215) 829-3409
(215) 925-9749
Mailing address
299 S 8TH ST, PHILADELPHIA, PA 19106-4010
(215) 829-3409
(215) 925-9749
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2256686000
KEYSTONE
—
01
—
5900
AETNA GROUP
—
Enumeration date
11/14/2006
Last updated
08/22/2020
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