MEDICARE: BRUCE KEITH BROWNSTEIN M.D.

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	207W00000X	Ophthalmology Physician	MD020980E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0053126000	OTHER	PA	IBX HMO IDENTIFIER

General Provider Information

NPI Number	:	1821036773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE KEITH BROWNSTEIN M.D.

Provider Business Mailing Address
First Line	:	1 PENN BLVD
Second Line	:	SUITE 102
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-1476
Country	:	US
Telephone Number	:	215-438-2020
Fax Number	:	215-951-8985

Provider Business Practice Location Address
First Line	:	1 PENN BLVD
Second Line	:	SUITE 102
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-1476
Country	:	US
Telephone Number	:	215-438-2020
Fax Number	:	215-951-8985

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	11/07/2007

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