Provider Demographics
NPI:1588717565
Name:EASTERN PENNSYLVANIA INFECTIOUS DISEASE ASSOCIATES, LLC
Entity type:Organization
Organization Name:EASTERN PENNSYLVANIA INFECTIOUS DISEASE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:NAKOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-596-4220
Mailing Address - Street 1:649 N LEWIS RD STE 220
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1234
Mailing Address - Country:US
Mailing Address - Phone:610-481-9600
Mailing Address - Fax:610-481-0225
Practice Address - Street 1:649 N LEWIS RD STE 220
Practice Address - Street 2:
Practice Address - City:LIMERICK
Practice Address - State:PA
Practice Address - Zip Code:19468-1234
Practice Address - Country:US
Practice Address - Phone:610-481-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-21
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069250L207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA108066Medicare PIN
PAH35481Medicare UPIN