Provider Demographics
NPI:1124024138
Name:ST. LAWRENCE MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:ST. LAWRENCE MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCGARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-779-1330
Mailing Address - Street 1:120 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-2871
Mailing Address - Country:US
Mailing Address - Phone:610-779-1330
Mailing Address - Fax:610-779-7699
Practice Address - Street 1:120 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-2871
Practice Address - Country:US
Practice Address - Phone:610-779-1330
Practice Address - Fax:610-779-7699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA97299Medicare ID - Type Unspecified