Provider Demographics
NPI:1063830669
Name:TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
Entity type:Organization
Organization Name:TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, FINANCE AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-710-2508
Mailing Address - Street 1:41 UNIVERSITY DR
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:734-343-2654
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:1057 SECOND STREET PIKE
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1803
Practice Address - Country:US
Practice Address - Phone:215-710-2770
Practice Address - Fax:215-710-2772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty