MEDICARE: BRYANNE ROBSON 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	207Q00000X	Family Medicine Physician	C1-0012677	DE
2	390200000X	Student in an Organized Health Care Education/Training Program	MT201249	PA
3	207Q00000X	Family Medicine Physician	MD453794	PA

General Provider Information

NPI Number	:	1386905230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYANNE ROBSON M.D.

Provider Business Mailing Address
First Line	:	1786 WILMINGTON W CHESTER PIKE STE 202A
Second Line	:
City	:	GLEN MILLS
State	:	PA
Zip	:	19342-8198
Country	:	US
Telephone Number	:	610-557-8903
Fax Number	:	610-486-3019

Provider Business Practice Location Address
First Line	:	1786 WILMINGTON W CHESTER PIKE STE 202A
Second Line	:
City	:	GLEN MILLS
State	:	PA
Zip	:	19342-8198
Country	:	US
Telephone Number	:	610-557-8903
Fax Number	:	610-486-3019

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

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	03/08/2022

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