Provider Demographics
NPI:1033116892
Name:CENTER FOR UROLOGIC CARE OF BERKS CO PC
Entity type:Organization
Organization Name:CENTER FOR UROLOGIC CARE OF BERKS CO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BUCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:610-685-4510
Mailing Address - Street 1:1320 BROADCASTING RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3222
Mailing Address - Country:US
Mailing Address - Phone:610-685-1044
Mailing Address - Fax:610-685-1009
Practice Address - Street 1:1320 BROADCASTING RD
Practice Address - Street 2:SUITE 210
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3222
Practice Address - Country:US
Practice Address - Phone:610-685-1044
Practice Address - Fax:610-685-1009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR UROLOGIC CARE OF BERKS CO PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-07
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16741501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1868OtherHIGHMARK BS FACILITY NUMB
PA390849OtherCAPITAL BC FACILITY
PA390849OtherCAPITAL BC FACILITY