Healthcare Provider Details

I. General information

NPI: 1356547558
Provider Name (Legal Business Name): STEVEN M BRUNELLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST WHITE BUILDING SUITE 210
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

311 FITZWATER ST
PHILADELPHIA PA
19147-3203
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-4000
  • Fax:
Mailing address:
  • Phone: 215-662-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD422830
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: