Healthcare Provider Details

I. General information

NPI: 1942263710
Provider Name (Legal Business Name): WAYNE R. BREARLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 04/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S LINCOLN AVE
LEBANON PA
17042-7529
US

IV. Provider business mailing address

127 KNOXLYN FARM DR
KENNETT SQUARE PA
19348-2738
US

V. Phone/Fax

Practice location:
  • Phone: 717-272-6621
  • Fax:
Mailing address:
  • Phone: 610-444-1829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC1-0009272
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD032858E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: