Provider Demographics
NPI:1366980351
Name:PROGRESSIVE GYNECOLOGY PLLC
Entity type:Organization
Organization Name:PROGRESSIVE GYNECOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THEA
Authorized Official - Middle Name:COOPER
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:484-459-8629
Mailing Address - Street 1:2603 DEKALB PIKE
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1818
Mailing Address - Country:US
Mailing Address - Phone:484-680-7374
Mailing Address - Fax:484-612-4619
Practice Address - Street 1:2603 DEKALB PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1818
Practice Address - Country:US
Practice Address - Phone:484-680-7374
Practice Address - Fax:484-612-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013045207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty