Provider Demographics
NPI:1104989078
Name:INTERNAL MEDICINE ASSOCIATES, P C
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CILETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-869-3620
Mailing Address - Street 1:1011 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9446
Mailing Address - Country:US
Mailing Address - Phone:610-869-3620
Mailing Address - Fax:610-869-0358
Practice Address - Street 1:1011 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 301
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9446
Practice Address - Country:US
Practice Address - Phone:610-869-3620
Practice Address - Fax:610-869-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004477L207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00128877600001Medicaid
PA075600Medicare PIN
PA00128877600001Medicaid