Provider Demographics
NPI:1194930883
Name:DARBY MEDICAL ASSOCIATES INC.
Entity type:Organization
Organization Name:DARBY MEDICAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CELSUS
Authorized Official - Middle Name:IEGBEOJAI
Authorized Official - Last Name:EBBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-461-2440
Mailing Address - Street 1:869 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-2105
Mailing Address - Country:US
Mailing Address - Phone:610-461-2440
Mailing Address - Fax:610-461-2475
Practice Address - Street 1:869 MAIN ST
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-2105
Practice Address - Country:US
Practice Address - Phone:610-461-2440
Practice Address - Fax:610-461-2475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047028L261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0509677001OtherKEYSTONE
PA737499OtherAETNA
PA040478OtherAETNA
PA040478OtherAETNA
PA737499OtherAETNA
PA=========OtherTAX ID NUM