Provider Demographics
NPI:1962734806
Name:PMR MEDICAL
Entity type:Organization
Organization Name:PMR MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-632-0646
Mailing Address - Street 1:425 CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19074-1414
Mailing Address - Country:US
Mailing Address - Phone:610-632-0646
Mailing Address - Fax:610-532-1252
Practice Address - Street 1:425 CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:PA
Practice Address - Zip Code:19074-1414
Practice Address - Country:US
Practice Address - Phone:610-632-0646
Practice Address - Fax:610-532-1252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-0052969-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA51709Medicare PIN