Provider Demographics
NPI:1386984052
Name:MAINLINE HEALTH ASSOCIATES
Entity type:Organization
Organization Name:MAINLINE HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:S J
Authorized Official - Last Name:KIDWAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-667-1115
Mailing Address - Street 1:2 BALA PLZ
Mailing Address - Street 2:STE IL50
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1501
Mailing Address - Country:US
Mailing Address - Phone:610-667-1115
Mailing Address - Fax:610-667-8008
Practice Address - Street 1:2 BALA PLZ
Practice Address - Street 2:STE IL50
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1501
Practice Address - Country:US
Practice Address - Phone:610-667-1115
Practice Address - Fax:610-667-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty