Healthcare Provider Details

I. General information

NPI: 1396056941
Provider Name (Legal Business Name): MISHA H BRIERE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W CHESTER PIKE STE 203
HAVERTOWN PA
19083-4540
US

IV. Provider business mailing address

PO BOX 5228
WEST CHESTER PA
19380-0405
US

V. Phone/Fax

Practice location:
  • Phone: 610-789-7767
  • Fax:
Mailing address:
  • Phone: 610-359-5672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS018555
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberOS018555
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: