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General NPI Number Information
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NPI Number | 1275823973
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Entity Type | Organization
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Legal Business Name | COLON AND RECTAL WELLNESS CENTER
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Dates
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Enumeration Date | 04/14/2011
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Last Update Date | 05/27/2011
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Provider Practice Location Address
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Address Line | 105 BRANDT DR SUITE 202
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-6437
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Country | US
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Telephone | 724-538-3330
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Fax |
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Provider Business Mailing Address
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Address Line | 157 GRISTMILL LN
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City | ZELIENOPLE
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State | PA
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Zip | 16063-3119
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Country | US
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Telephone | 724-538-3330
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Fax |
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Authorized Official
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Title or Position | PRES/OWNER
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Name | BRADLEY A LEVINSON
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Credential | MD
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Telephone | 724-538-3330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | MD031375E
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License Number State | PA
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