Healthcare Provider Details

I. General information

NPI: 1972504017
Provider Name (Legal Business Name): BARI MICHELE BRANDT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 LANCASTER AVE
BERWYN PA
19312-1297
US

IV. Provider business mailing address

56 W EAGLE RD
HAVERTOWN PA
19083-1447
US

V. Phone/Fax

Practice location:
  • Phone: 610-384-9100
  • Fax: 610-384-3937
Mailing address:
  • Phone: 610-449-4336
  • Fax: 610-446-1735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD052464L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: