Healthcare Provider Details

I. General information

NPI: 1437557329
Provider Name (Legal Business Name): BCGI PATHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OXFORD VALLEY RD #701
YARDLEY PA
19067-7706
US

IV. Provider business mailing address

301 OXFORD VALLEY RD #701
YARDLEY PA
19067-7706
US

V. Phone/Fax

Practice location:
  • Phone: 215-321-7221
  • Fax: 215-321-9109
Mailing address:
  • Phone: 215-321-7221
  • Fax: 215-321-9109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD430131
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1063520096
Identifier TypeOTHER
Identifier State
Identifier IssuerBUCKS COUNTY GASTROENTEROLOGY NPI

VIII. Authorized Official

Name: DR. KENNETH BRESLIN
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 215-321-7221