MEDICARE: BRIAN J BROKER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	MD053007L	PA

General Provider Information

NPI Number	:	1346340007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN J BROKER M.D.

Provider Business Mailing Address
First Line	:	826 MAIN ST
Second Line	:	SUITE 201
City	:	PHOENIXVILLE
State	:	PA
Zip	:	19460-4459
Country	:	US
Telephone Number	:	610-415-1100
Fax Number	:	610-415-1101

Provider Business Practice Location Address
First Line	:	826 MAIN ST
Second Line	:	SUITE 201
City	:	PHOENIXVILLE
State	:	PA
Zip	:	19460-4459
Country	:	US
Telephone Number	:	610-415-1100
Fax Number	:	610-415-1101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2006
Last Update Date	:	03/09/2022

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