Provider Demographics
NPI:1174588727
Name:PHILADELPHIA UROSURGICAL ASSOCIATES PC
Entity type:Organization
Organization Name:PHILADELPHIA UROSURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-863-8100
Mailing Address - Street 1:207 N BROAD ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:215-863-8100
Mailing Address - Fax:215-587-6252
Practice Address - Street 1:207 N BROAD ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1500
Practice Address - Country:US
Practice Address - Phone:215-863-8100
Practice Address - Fax:215-587-6252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA913600Medicaid
PA913600Medicaid