Organization Active NPI

Internal Medicine Associates, P C

  • Adolescent Medicine (Internal Medicine) Physician
  • West Grove, PA
National Provider Identifier
1104989078
Registry record updated Feb 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0000X
License
OS004477L Issued in PA
Legal business name
INTERNAL MEDICINE ASSOCIATES, P C
Practice address
1011 W Baltimore Pike
Suite 301
West Grove, PA 19390-9446
Phone
(610) 869-3620
Fax
(610) 869-0358
NPI assigned
Dec 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Donna Ciletti
Title
Practice Manager
Phone
(610) 869-3620

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0000X OS004477L PA Primary

Addresses

Primary practice location

1011 W Baltimore Pike
Suite 301
West Grove, PA 19390-9446

Mailing address

1011 W Baltimore Pike
Suite 301
West Grove, PA 19390-9446
Phone (610) 869-3620

Other identifiers 1

IdentifierTypeStateIssuer
00128877600001MedicaidPA

National Provider Directory

National Provider Directory

Locations

1011 W Baltimore Pike
Ste 301
West Grove, PA 19390
Phone (610) 869-3620

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203033600000",
    "number": "1104989078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 W BALTIMORE PIKE",
            "address_2": "SUITE 301",
            "city": "WEST GROVE",
            "state": "PA",
            "postal_code": "193909446",
            "telephone_number": "610-869-3620",
            "fax_number": "610-869-0358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 W BALTIMORE PIKE",
            "address_2": "SUITE 301",
            "city": "WEST GROVE",
            "state": "PA",
            "postal_code": "193909446",
            "telephone_number": "610-869-3620",
            "fax_number": "610-869-0358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE ASSOCIATES, P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2008-02-15",
        "status": "A",
        "authorized_official_last_name": "CILETTI",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "610-869-3620",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RA0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": "PA",
            "license": "OS004477L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00128877600001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Grove, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.