Provider Demographics
NPI:1144521444
Name:TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
Entity type:Organization
Organization Name:TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KNAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-710-5874
Mailing Address - Street 1:PO BOX 827477
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-8274
Mailing Address - Country:US
Mailing Address - Phone:978-474-8885
Mailing Address - Fax:978-474-8845
Practice Address - Street 1:295 BUCK RD
Practice Address - Street 2:SUITE 204
Practice Address - City:HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:18966-1733
Practice Address - Country:US
Practice Address - Phone:215-355-7074
Practice Address - Fax:215-355-5706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006210L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty