MEDICARE: EMILY JEAN BRUNNER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0216X	Pediatric Rheumatology Physician	OS016286	PA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207RR0500X	Rheumatology Physician	OS016286	PA

General Provider Information

NPI Number	:	1487979407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY JEAN BRUNNER D.O.

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-4903
Country	:	US
Telephone Number	:	570-271-6144
Fax Number	:	570-271-6578

Provider Business Practice Location Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-1334
Country	:	US
Telephone Number	:	570-271-6416
Fax Number	:	570-214-2924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2010
Last Update Date	:	08/06/2020

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