WESTERN MAIN LINE UROLOGY PC (NPI# 1396869012) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396869012 |
| Entity Type | Organization |
| Organization Name | WESTERN MAIN LINE UROLOGY PC |
| Practice Address |
255 W Lancaster Ave Suite 333 Paoli PA 19301-1763 |
| Practice Telephone | 6106449600 |
| Practice Fax Number | 6106440804 |
| Mailing Telephone | 6106449600 |
| Mailing Fax Number | 6106440804 |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2010-08-31 |
| Authorized Official Name | DR. GREGORY M THOMPSON (OWNER) |
| Authorized Official Telephone | 6106449600 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | MD04339E | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | HIGHMARK BS | 920504 | 01 |
| PA | IBC | 0866534000 | 01 |
| PA | 0011574150003 | 05 |
| Street Address |
255 W LANCASTER AVE SUITE 333 |
| City | PAOLI |
| State | PA |
| Zip Code | 19301-1763 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679576144 | Victoriya K Hageney | Internal Medicine | 255 W Lancaster Ave, Paoli, PA 19301-1763 | 2005-05-27 |
| 1548874597 | Tam T Nguyen | Registered Nurse | 255 W Lancaster Ave, Paoli, PA 19301-1763 | 2020-09-06 |
| 1447864020 | Monica Anne Disipio | Nurse Practitioner | 255 W Lancaster Ave, Paoli, PA 19301-1763 | 2020-09-01 |
| 1194340786 | Natalie Toner | Physician Assistant | 255 W Lancaster Ave, Paoli, PA 19301-1763 | 2020-06-10 |
| 1932732138 | Cynthia Ayoki Okech | Registered Nurse | 255 W Lancaster Ave, Paoli, PA 19301-1763 | 2020-02-15 |
| 1013552983 | Ashley Diane Olley | Physician Assistant | 255 W Lancaster Ave, Paoli, PA 19301-1763 | 2019-11-14 |
| 1982247078 | Kelsy Kauffman | Physician Assistant | 255 W Lancaster Ave, Paoli, PA 19301-1763 | 2019-10-22 |
| 1245880707 | Melissa Ann Stefanosky | Physician Assistant | 255 W Lancaster Ave, Paoli, PA 19301-1763 | 2019-09-17 |
| 1558923425 | Cara Rose Weinstein | Genetic Counselor, MS | 255 W Lancaster Ave, Paoli, PA 19301-1763 | 2019-07-01 |
| 1780240887 | Rachel Michalek | Nurse Practitioner | 255 W Lancaster Ave, Paoli, PA 19301-1763 | 2019-05-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588280333 | Mary Callery | Physical Therapy Assistant | 16 Industrial Blvd., Ste. 101, Paoli, PA 19301 | 2020-06-17 |
| 1871097519 | Daniel Malloy-good | Social Worker | 45 Darby Rd Ste E4, Paoli, PA 19301 | 2018-03-19 |
| 1306354774 | Patricia Obilo-azandegbe | Counselor | 30 S Valley Rd Ste 101, Paoli, PA 19301 | 2018-01-18 |
| 1275992877 | Jessica Bernard | Physical Therapist | 40 Darby Rd Ste 1, Paoli, PA 19301 | 2016-02-11 |
| 1730576364 | Ushma Sheth | Podiatrist | 250 W Lancaster Ave Ste 225, Paoli, PA 19301 | 2015-04-21 |
| 1619371432 | Miriam Leslie Brewer | Physical Therapist | 195 W Lancaster Ave #3, Paoli, PA 19301 | 2014-10-22 |
| 1447665393 | Matthew Rementer | Podiatrist | 254 West Lancaster Ave, Paoli, PA 19301 | 2014-06-29 |
| 1720490915 | Edward Anthony Romero | Surgery | 255 W Lancaster Ave Ste 332, Paoli, PA 19301 | 2014-05-22 |
| 1285053421 | Jose Ethan Pulido | Urology | 2 Industrial Blvd Bldg C Ste 120, Paoli, PA 19301 | 2014-04-15 |
| 1093065849 | Kathleen M Canfield | Physician Assistant | 11 Industrial Blvd., Ste 204, Paoli Pointe Med. Office Bldg, Paoli, PA 19301 | 2012-09-19 |
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| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285053421 | Jose Ethan Pulido | Urology | 2 Industrial Blvd Bldg C Ste 120, Paoli, PA 19301 | 2014-04-15 |
| 1396935912 | Joseph A Graversen | Urology | 209 W Lancaster Ave, Suite 200, Paoli, PA 19301-1749 | 2007-07-30 |
| 1922112119 | James R Bollinger, Md PC | Urology | 209 W Lancaster Ave, Suite 200, Paoli, PA 19301-1749 | 2006-08-18 |
| 1336156785 | James Richard Bollinger | Urology | 209 W Lancaster Ave, Suite 200, Paoli, PA 19301-1749 | 2006-08-01 |
| 1063410702 | Gregory M. Thompson | Urology | 255 W Lancaster Ave, Pmob IIi, Suite 333, Paoli, PA 19301-1763 | 2005-07-07 |
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| 1558859645 | East Freedom Surgical Associates, LLC | Urology | 15721 Dunnings Hwy, Duncansville, PA 16635 | 2018-04-25 |
| 1528560943 | Lancaster Urology PC | Urology | 175 Martin Ave Ste 300, Ephrata, PA 17522-1761 | 2018-03-01 |
| 1841706561 | Urology of Central Pennsylvania, Inc | Urology | 815 Sir Thomas Ct Ste 100, Harrisburg, PA 17109-4839 | 2017-12-18 |
| 1003326869 | St Luke's Physician Group Inc | Urology | 5325 Northgate Dr Ste 203, Bethlehem, PA 18017-9413 | 2017-10-06 |
| 1952829350 | Centers for Advanced Urology, LLC | Urology | 140 W Germantown Pike Ste 250, Plymouth Meeting, PA 19462-1421 | 2017-09-06 |
| 1346767944 | Nazareth Physician Services | Urology | 2701 Holme Ave Ste 101, Phila, PA 19152-2029 | 2017-08-24 |
| 1710403191 | Mercy Management of Sepa | Urology | 501 S 54th St Ste 227, Phila, PA 19143-1900 | 2017-08-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.