Modern Family Medicine Main Line LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MODERN FAMILY MEDICINE MAIN LINE LLC

Practice address

864 County Line Rd
Bryn Mawr, PA 19010-2516

Phone

(484) 222-6222

NPI assigned

Apr 5, 2018

Organization subpart

No

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

Authorized official

Name

David Ho, MDNPI 1083856918

Title

Owner

Phone

(484) 222-6222

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 3

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

• David M Ho, M.D.

  • Family Medicine Physician
  • Bryn Mawr, PA
  • NPI 1083856918
  Medicare reassignment NPD Authorized official
• Lily An Ngo, PA-C

  • Physician Assistant
  • Bryn Mawr, PA
  • NPI 1801554555
  NPD
• Todd Sweeney, PA-C

  • Physician Assistant
  • Bryn Mawr, PA
  • NPI 1417613753
  NPD

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

{
    "created_epoch": "1522886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522886400000",
    "number": "1245736446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "864 COUNTY LINE RD",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190102516",
            "telephone_number": "484-222-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "864 COUNTY LINE RD",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190102516",
            "telephone_number": "484-222-6222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN FAMILY MEDICINE MAIN LINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-05",
        "last_updated": "2018-04-05",
        "status": "A",
        "authorized_official_last_name": "HO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "484-222-6222",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharon Mirakian, CRNA
• Sarim Mohammed Mirza, MD
• Vallabhi Mishra
• Anne B Mitchell, CRNP
• Holland Mittl
• Ronald Dial Mojica, MD
• Sophia Moldavsky, M.D.
• Philip Moldofsky, M.D.
• Moll Premier Primary Care LLC
• Momenta Chiropractic LLC

• Family Medicine Physician in Bryn Mawr, PA
• Providers in Bryn Mawr, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.