Healthcare Provider Details

I. General information

NPI: 1245213578
Provider Name (Legal Business Name): WILLIAM F BRAZEROL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 W LINCOLN HWY COMMONS AT OAKLANDS
EXTON PA
19341-2547
US

IV. Provider business mailing address

728 W LINCOLN HWY COMMONS AT OAKLANDS
EXTON PA
19341-2547
US

V. Phone/Fax

Practice location:
  • Phone: 610-903-6200
  • Fax:
Mailing address:
  • Phone: 610-903-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD046137L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier740840
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBS BC
# 2
Identifier2017452
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: