Healthcare Provider Details

I. General information

NPI: 1902849615
Provider Name (Legal Business Name): BERNARD R. HURLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 WALNUT STREET SUITE 1020
PHILADELPHIA PA
19107-5109
US

IV. Provider business mailing address

840 WALNUT STREET SUITE 1020
PHILADELPHIA PA
19107-5109
US

V. Phone/Fax

Practice location:
  • Phone: 215-928-3300
  • Fax: 215-825-4723
Mailing address:
  • Phone: 215-928-3300
  • Fax: 215-825-4723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD424010
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMT184531
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: