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General NPI Number Information
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NPI Number | 1417059908
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Entity Type | Individual
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Provider Name | ALAN BART BRACKUP M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/04/2006
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Last Update Date | 03/25/2021
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Provider Practice Location Address
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Address Line | 1717 LANGHORNE NEWTOWN RD STE 150
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City | LANGHORNE
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State | PA
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Zip | 19047-1089
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Country | US
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Telephone | 215-750-9400
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Fax | 215-750-7400
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Provider Business Mailing Address
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Address Line | 1717 LANGHORNE NEWTOWN RD STE 150
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City | LANGHORNE
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State | PA
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Zip | 19047-1089
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Country | US
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Telephone | 215-750-9400
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Fax | 215-750-7400
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD044284E
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | MD044284E
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License Number State | PA
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