Healthcare Provider Details

I. General information

NPI: 1811576713
Provider Name (Legal Business Name): KAITLYN ALANA BRETTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BRICK RD STE 115
MARLTON NJ
08053-2146
US

IV. Provider business mailing address

928 LINWOOD AVE
COLLINGSWOOD NJ
08108-3242
US

V. Phone/Fax

Practice location:
  • Phone: 856-983-1400
  • Fax: 856-983-1681
Mailing address:
  • Phone: 701-240-0083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA13199100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: