MEDICARE: BRANTZ & LIEDMAN ASSOCIATES P.C.

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	207Q00000X	Family Medicine Physician	OS003987L	PA

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	:	1619922580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANTZ & LIEDMAN ASSOCIATES P.C.

Provider Business Mailing Address
First Line	:	841 E HUNTING PARK AVE
Second Line	:	SUITE 110
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-4800
Country	:	US
Telephone Number	:	213-535-4494
Fax Number	:	215-535-4203

Provider Business Practice Location Address
First Line	:	841 E HUNTING PARK AVE
Second Line	:	SUITE 110
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-4800
Country	:	US
Telephone Number	:	213-535-4494
Fax Number	:	215-535-4203

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD MICHAEL BRANTZ
Credential	:	D.O.
Telephone Number	:	215-535-4494

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	02/12/2010

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Directions to “BRANTZ & LIEDMAN ASSOCIATES P.C. ” Practice Location

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