Provider Demographics
NPI:1669569562
Name:VALLEY FORGE UROLOGICAL ASSN., P.C.
Entity type:Organization
Organization Name:VALLEY FORGE UROLOGICAL ASSN., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUS
Authorized Official - Middle Name:
Authorized Official - Last Name:SPECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-933-1133
Mailing Address - Street 1:824 MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4478
Mailing Address - Country:US
Mailing Address - Phone:610-933-1133
Mailing Address - Fax:610-933-4238
Practice Address - Street 1:824 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4478
Practice Address - Country:US
Practice Address - Phone:610-933-1133
Practice Address - Fax:610-933-4238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACG7038OtherPALMETTO GBA - RR MC
PA0017773030003Medicaid
PA0017773030003Medicaid
PACG7038OtherPALMETTO GBA - RR MC