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2510 Maryland Rd Suite 185 Willow Grove PA 19090-1109 | |
(215) 481-4323 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 2510 Maryland Rd, Willow Grove, Pennsylvania |
Authorized Official Name and Position | Michael B Walsh (SENIOR VICE PRESIDENT OF FINANCE) |
Authorized Official Contact | 2154812000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 826594 Philadelphia PA 19182-6594 Ph: (215) 481-4323 | 2510 Maryland Rd Suite 185 Willow Grove PA 19090-1109 Ph: (215) 481-4323 |
NPI Number | 1861742900 |
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Provider Enumeration Date | 09/17/2012 |
Last Update Date | 10/12/2022 |
Medicare PECOS PAC ID | 3274437736 |
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Medicare Enrollment ID | O20180420001807 |
Identifier | Type | State | Issuer |
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1861742900 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Primary |
207T00000X | Neurological Surgery | (* (Not Available)) | Secondary |
Provider Name | Douglas Walter Laske |
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Provider Type | Practitioner - Neurosurgery |
Provider Identifiers | NPI Number: 1275521254 PECOS PAC ID: 0345146387 Enrollment ID: I20031210000585 |
Provider Name | Michael J Graveley |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1558351668 PECOS PAC ID: 7810957263 Enrollment ID: I20041012000293 |
Provider Name | Steven Barrer |
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Provider Type | Practitioner - Neurosurgery |
Provider Identifiers | NPI Number: 1194766386 PECOS PAC ID: 6204843741 Enrollment ID: I20100623000342 |
Provider Name | Michael S Yoon |
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Provider Type | Practitioner - Neurosurgery |
Provider Identifiers | NPI Number: 1821039090 PECOS PAC ID: 6507997731 Enrollment ID: I20100701000364 |
Provider Name | Jonas J Gopez |
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Provider Type | Practitioner - Neurosurgery |
Provider Identifiers | NPI Number: 1083652051 PECOS PAC ID: 3577696541 Enrollment ID: I20100728000946 |
Provider Name | Susan Kuchera |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1184822504 PECOS PAC ID: 9032305586 Enrollment ID: I20101123000126 |
North Willow Grove Family Medicine Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2701 Blair Mill Rd, Suite 20, Willow Grove, PA 19090 Phone: 215-672-7070 Fax: 215-672-6426 | |
Montgomery County Advanced Medical Imaging, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2701 Blair Mill Rd, Blairwood Bldg. Suite 9, Willow Grove, PA 19090 Phone: 215-481-3377 Fax: 215-481-7682 | |