Provider Demographics
NPI:1225082316
Name:PULMONARYDISEASESLTD
Entity type:Organization
Organization Name:PULMONARYDISEASESLTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-952-0888
Mailing Address - Street 1:505 BENTLEY CT
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2359
Mailing Address - Country:US
Mailing Address - Phone:610-952-0888
Mailing Address - Fax:
Practice Address - Street 1:520 MAPLE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4434
Practice Address - Country:US
Practice Address - Phone:610-952-0888
Practice Address - Fax:610-524-2314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018425E207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA091284Medicare ID - Type UnspecifiedPROVIDER NUMBER