Provider Demographics
NPI:1386786648
Name:DELAWARE COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:DELAWARE COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-338-8228
Mailing Address - Street 1:501 NORTH LANSDOWNE AVENUE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1114
Mailing Address - Country:US
Mailing Address - Phone:610-284-8100
Mailing Address - Fax:610-447-6620
Practice Address - Street 1:501 NORTH LANSDOWNE AVENUE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1114
Practice Address - Country:US
Practice Address - Phone:610-284-8100
Practice Address - Fax:610-447-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA041801341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007725667Medicaid
PA390081Medicare Oscar/Certification