Healthcare Provider Details

I. General information

NPI: 1942933056
Provider Name (Legal Business Name): BROKER,CRAMER & SWANSON ENT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 OLD LANCASTER RD STE 300
BRYN MAWR PA
19010-3235
US

IV. Provider business mailing address

826 MAIN ST STE 201
PHOENIXVILLE PA
19460-4459
US

V. Phone/Fax

Practice location:
  • Phone: 610-415-1100
  • Fax: 610-415-1101
Mailing address:
  • Phone: 610-415-1100
  • Fax: 610-415-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BECKY MANDERACH
Title or Position: CREDENTIALING
Credential:
Phone: 610-415-1100