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Contact Information

MAIN LINE AFFILIATES
1 RADNOR CORPORATE CTR
SUITE 400
RADNOR, PA19087-4515
 Phone: 610-254-1450
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychiatry

2084P0800X 26 Physician/Psychiatry
 

Addiction (Substance Use Disorder)

101YA0400X
 

Addiction Psychiatry

2084P0802X 86 Physician/Neuropsychiatry
 

Adult Mental Health

261QM0850X
 

Child & Adolescent Psychiatry

2084P0804X 86 Physician/Neuropsychiatry
 

Clinical

103TC0700X 62 Psychologist, Clinical
 

Clinical Neuropsychologist

103G00000X
 

Psychologist

103T00000X 62 Psychologist, Clinical
 

Rehabilitation

103TR0400X 62 Psychologist, Clinical
 

Rehabilitation, Substance Use Disorder

261QR0405X
Indicates primary specialty

NPI Profile & details for MAIN LINE AFFILIATES

NPI Number 1083777239
LBN Legal business name MAIN LINE AFFILIATES
Authorized official MICHAEL BUONGIORNO - (EXEC. VP & CFO)
Entity Organization
Organization subpart 1 No
Enumeration date 12/19/2006
Last updated 05/18/2016 - About 10 years ago
Identifiers
PA License # 151081
PA License # 237078
PA Medicaid 1007726370011
Other 0470009 AETNA HMO - BMR PSYCH
Other 2983830 AETNA HMO - CAD DREX HILL
Other 2983910 AETNA HMO - CAD EXTON
Other 7985197 AETNA PPO - MLA
Other 2089834 CIGNA - CAD DREXEL HILL
Other 2089835 CIGNA - CAD EXTON
Other 0664704000 IBC - BMR PSYCH ASSOC
Other 2317419000 IBC - MLA
Other 280110000 MAGELLAN - CAD DREXEL HIL
Other 231200000 MAGELLAN - CAD EXTON
Other 471443000 MAGELLAN - MLA
Other 101823 UNITED - CAD - ADULT PHP
Other 101825 UNITED - CAD ADOLESCENT
Other 101824 UNITED - CAD ADULT IOP
Other 293195 VALUEOPTIONS - MLA
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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