Provider Demographics
NPI:1285691212
Name:CITY LINE FAMILY MEDICINE P.C.
Entity type:Organization
Organization Name:CITY LINE FAMILY MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANGELONI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-617-1300
Mailing Address - Street 1:301 E CITY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1708
Mailing Address - Country:US
Mailing Address - Phone:610-617-1300
Mailing Address - Fax:610-617-0199
Practice Address - Street 1:301 E CITY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1708
Practice Address - Country:US
Practice Address - Phone:610-617-1300
Practice Address - Fax:610-617-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA052341Medicare ID - Type Unspecified