Healthcare Provider Details

I. General information

NPI: 1730353731
Provider Name (Legal Business Name): KRISTIN BRESNAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2166 S 12TH ST
ALLENTOWN PA
18103-8701
US

IV. Provider business mailing address

PO BOX 783311
PHILADELPHIA PA
19178-3311
US

V. Phone/Fax

Practice location:
  • Phone: 610-969-0100
  • Fax:
Mailing address:
  • Phone: 610-798-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberMD435850
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: