Provider Demographics
NPI:1841364510
Name:SUBURBAN PRIMARY CARE
Entity type:Organization
Organization Name:SUBURBAN PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-356-0300
Mailing Address - Street 1:3475 W CHESTER PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4280
Mailing Address - Country:US
Mailing Address - Phone:610-356-0300
Mailing Address - Fax:610-356-1981
Practice Address - Street 1:3475 W CHESTER PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4280
Practice Address - Country:US
Practice Address - Phone:610-356-0300
Practice Address - Fax:610-356-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA085555OtherAETNA ID
PA0142949001OtherKEYSTONE ID