Provider Demographics
NPI:1316131360
Name:MARYWOOD UNIVERSITY
Entity type:Organization
Organization Name:MARYWOOD UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:570-840-2252
Mailing Address - Street 1:2300 ADAMS AVENUE
Mailing Address - Street 2:ONEILL CENTER FOR HEALTHY FAMILIES
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509
Mailing Address - Country:US
Mailing Address - Phone:570-340-6069
Mailing Address - Fax:570-340-6067
Practice Address - Street 1:2300 ADAMS AVENUE
Practice Address - Street 2:ONEILL CENTER FOR HEALTHY FAMILIES
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509
Practice Address - Country:US
Practice Address - Phone:570-340-6069
Practice Address - Fax:570-340-6067
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARYWOOD UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032293E207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports MedicineGroup - Single Specialty