MEDICARE: MR. TODD CULBREATH

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	237700000X	Hearing Instrument Specialist	F03105	PA

General Provider Information

NPI Number	:	1851762678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TODD CULBREATH

Provider Business Mailing Address
First Line	:	3212 W CHELTENHAM AVE STE 2
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19150-1003
Country	:	US
Telephone Number	:	610-203-6900
Fax Number	:	610-203-6900

Provider Business Practice Location Address
First Line	:	3212 W CHELTENHAM AVE STE 2
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19150-1003
Country	:	US
Telephone Number	:	161-020-3690
Fax Number	:

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

Provider Enumeration Date	:	10/20/2015
Last Update Date	:	03/25/2021

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