Healthcare Provider Details

I. General information

NPI: 1255248431
Provider Name (Legal Business Name): BRYAN MARGERUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 GREENWOOD AVE
WYNCOTE PA
19095-1821
US

IV. Provider business mailing address

414 GREENWOOD AVE
WYNCOTE PA
19095-1821
US

V. Phone/Fax

Practice location:
  • Phone: 215-776-9289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD062780L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: