Provider Demographics
NPI:1306950704
Name:CARE LEVEL MANAGEMENT MEDICAL GROUP OF PENNSYLVANIA PC
Entity type:Organization
Organization Name:CARE LEVEL MANAGEMENT MEDICAL GROUP OF PENNSYLVANIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR STAFFING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-595-8180
Mailing Address - Street 1:5700 CANOGA AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6582
Mailing Address - Country:US
Mailing Address - Phone:800-377-3606
Mailing Address - Fax:818-595-8101
Practice Address - Street 1:1400 N PROVIDENCE RD
Practice Address - Street 2:SUITE 1025
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2043
Practice Address - Country:US
Practice Address - Phone:610-892-8991
Practice Address - Fax:610-892-8966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherTIN