Healthcare Provider Details

I. General information

NPI: 1457334047
Provider Name (Legal Business Name): DEANNA R. BRASILE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 OLD LANCASTER RD STE 170
BRYN MAWR PA
19010-3234
US

IV. Provider business mailing address

PO BOX 631790
CINCINNATI OH
45263-1790
US

V. Phone/Fax

Practice location:
  • Phone: 610-527-0800
  • Fax: 610-527-9868
Mailing address:
  • Phone: 615-550-4900
  • Fax: 615-550-4941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS012004
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MB07415400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number25MB07415400
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberOS012004
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: