Provider Demographics
NPI:1871517540
Name:DELAWARE VALLEY I.D. ASSOCIATES, P.C.
Entity type:Organization
Organization Name:DELAWARE VALLEY I.D. ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE AND OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVALLARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-896-0210
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:MOB EAST 556
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-896-0210
Mailing Address - Fax:610-896-5101
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:MOB EAST 556
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-896-0210
Practice Address - Fax:610-896-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01886952Medicaid
PA097746OtherINDEPENDENCE BLUE CROSS
PA0061398000OtherKEYSTONE HEALTH PLAN EAST
PA54910OtherAETNA
PA0061398000OtherKEYSTONE HEALTH PLAN EAST