Healthcare Provider Details

I. General information

NPI: 1205832177
Provider Name (Legal Business Name): DAVID BRONSTEIN DO RICHARD H JEFFRIES DO PROFESSIONAL ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 LONDONDERRY RD
HARRISBURG PA
17109-5207
US

IV. Provider business mailing address

4830 LONDONDERRY RD
HARRISBURG PA
17109-5207
US

V. Phone/Fax

Practice location:
  • Phone: 717-657-2595
  • Fax: 717-441-0116
Mailing address:
  • Phone: 717-657-2595
  • Fax: 717-441-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: DR. DAVID BRONSTEIN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 717-657-2595