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General NPI Number Information
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NPI Number | 1891836276
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Entity Type | Organization
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Legal Business Name | DOUGLAS J. BRUNNER, M. D.
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 175 E CHESTER PIKE
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City | RIDLEY PARK
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State | PA
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Zip | 19078-2212
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Country | US
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Telephone | 610-595-6542
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Fax | 610-595-6077
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Provider Business Mailing Address
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Address Line | 175 E CHESTER PIKE
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City | RIDLEY PARK
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State | PA
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Zip | 19078-2212
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Country | US
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Telephone | 610-595-6521
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Fax | 610-595-6077
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Authorized Official
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Title or Position | MD
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Name | DR. DOUGLAS J. BRUNNER
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Credential | MD
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Telephone | 610-595-6521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MD027564E
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License Number State | PA
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