Provider Demographics
NPI:1548218902
Name:TWIN RIVERS SURGICAL GROUP, LLP
Entity type:Organization
Organization Name:TWIN RIVERS SURGICAL GROUP, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DEPALMA
Authorized Official - Suffix:
Authorized Official - Credentials:CMM
Authorized Official - Phone:610-253-6201
Mailing Address - Street 1:3735 EASTON NAZARETH HWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-8338
Mailing Address - Country:US
Mailing Address - Phone:610-253-6201
Mailing Address - Fax:610-258-4705
Practice Address - Street 1:3735 EASTON NAZARETH HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8338
Practice Address - Country:US
Practice Address - Phone:610-253-6201
Practice Address - Fax:610-258-4705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02282400OtherCAPITAL BLUE CROSS
PA866601OtherHIGHMARK BLUE SHIELD
PA0016052290005Medicaid
PA02282400OtherCAPITAL BLUE CROSS