MEDICARE: DR. BRYAN A. PUKENAS MD

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	2085R0202X	Diagnostic Radiology Physician	25MA08447100	PA
2	2085N0700X	Neuroradiology Physician	MD434337	PA
3	2085R0001X	Radiation Oncology Physician	MD434337	PA
4	2085R0202X	Diagnostic Radiology Physician	MD434337	PA
5	2085R0202X	Diagnostic Radiology Physician	25MA08447100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588713499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN A. PUKENAS MD

Provider Business Mailing Address
First Line	:	800 SPRUCE STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-6130
Country	:	US
Telephone Number	:	215-829-3201
Fax Number	:	215-829-5697

Provider Business Practice Location Address
First Line	:	800 SPRUCE STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-6130
Country	:	US
Telephone Number	:	215-829-3201
Fax Number	:	215-829-5697

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	05/13/2026

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