Healthcare Provider Details

I. General information

NPI: 1235346958
Provider Name (Legal Business Name): PHILIP CORNELIUS BREEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 RAYLOC DR
HANCOCK MD
21750-1518
US

IV. Provider business mailing address

525 FULTON DR
MC CONNELLSBURG PA
17233-8061
US

V. Phone/Fax

Practice location:
  • Phone: 301-678-5187
  • Fax: 301-678-5797
Mailing address:
  • Phone: 717-485-3850
  • Fax: 717-485-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD016955E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: