Provider Demographics
NPI:1174570220
Name:PAOLI OB/GYN ASSOCIATES, P.C.
Entity type:Organization
Organization Name:PAOLI OB/GYN ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUSSINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-896-7550
Mailing Address - Street 1:100 E LANCASTER AVE STE 660
Mailing Address - Street 2:LANKENAU MEDICAL BUILDING EAST
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-896-7550
Mailing Address - Fax:610-896-7914
Practice Address - Street 1:100 E LANCASTER AVE STE 660
Practice Address - Street 2:LANKENAU MEDICAL BUILDING EAST
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-896-7550
Practice Address - Fax:610-896-7914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA51756OtherHIGHMARK BLUE SHIELD
PA504367OtherAETNA
PA0661441000OtherINDEPENDENCE BLUE CROSS
PA51756OtherHIGHMARK BLUE SHIELD