Main Line Health Integrative and Functional Medicine

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

MAIN LINE HEALTH INTEGRATIVE AND FUNCTIONAL MEDICINE

Practice address

3803 W Chester Pike Ste 160
Newtown Square, PA 19073

Phone

(484) 337-1585

Fax

(484) 337-1410

NPI assigned

May 10, 2018

Last updated

Apr 28, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Andrea Gilbert

Title

President

Phone

(484) 337-3570

Specialties & licenses 1

Addresses

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Benjamin Alexander Ehrlich, DO

  • Neurology Physician
  • Bryn Mawr, PA
  • NPI 1770871071
  NPD
• Gbambele Kone

  • Neurology Physician
  • Philadelphia, PA
  • NPI 1164912069
  NPD
• Christine A Gearhart, CRNP

  • Family Nurse Practitioner
  • Radnor, PA
  • NPI 1174572622
  NPD (past)
• Randall Barry Faber, PA-C

  • Physician Assistant
  • Vineland, NJ
  • NPI 1205105954
  NPD (past)

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

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651104000000",
    "number": "1437649985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3803 W CHESTER PIKE STE 160",
            "city": "NEWTOWN SQUARE",
            "state": "PA",
            "postal_code": "190732336",
            "telephone_number": "484-337-1585",
            "fax_number": "484-337-1410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3803 W CHESTER PIKE STE 160",
            "city": "NEWTOWN SQUARE",
            "state": "PA",
            "postal_code": "19073",
            "telephone_number": "484-337-1585",
            "fax_number": "484-337-1410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN LINE HEALTH INTEGRATIVE AND FUNCTIONAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-10",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A",
        "authorized_official_last_name": "GILBERT",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "484-337-3570"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlin Madden, DPM
• Mahon Medical Innovations Inc (MoveMed)
• David M Mahon, DO
• Diana Mahoney, LCSW
• Gioia Maiale, DPT
• Main Line Health Laboratories
• Main Line Healthcare
• Tara Sherie Major, CRNP
• David A. Malone, D.M.D.
• Eric Robert Mankin, MD

• Multi-Specialty Clinic/Center in Newtown Square, PA
• Providers in Newtown Square, PA by specialty
• Multi-Specialty Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; 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.