Provider Demographics
NPI:1053559021
Name:MAIN LINE FAMILY PRACTICE
Entity type:Organization
Organization Name:MAIN LINE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:LIANE
Authorized Official - Last Name:HARGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-995-7741
Mailing Address - Street 1:227 WINSOR LN
Mailing Address - Street 2:
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1822
Mailing Address - Country:US
Mailing Address - Phone:610-642-7741
Mailing Address - Fax:
Practice Address - Street 1:888 GLENBROOK AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2506
Practice Address - Country:US
Practice Address - Phone:610-525-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 430289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty