Provider Demographics
NPI:1205832177
Name:DAVID BRONSTEIN DO RICHARD H JEFFRIES DO PROFESSIONAL ASSOC
Entity Type:Organization
Organization Name:DAVID BRONSTEIN DO RICHARD H JEFFRIES DO PROFESSIONAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BRONSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-657-2595
Mailing Address - Street 1:4830 LONDONDERRY RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5207
Mailing Address - Country:US
Mailing Address - Phone:717-657-2595
Mailing Address - Fax:717-441-0116
Practice Address - Street 1:4830 LONDONDERRY RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5207
Practice Address - Country:US
Practice Address - Phone:717-657-2595
Practice Address - Fax:717-441-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207R00000X, 207RH0003X, 207RI0200X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2425999OtherAETNA
PA02790500OtherCAPITAL BLUE CROSS
PA133259OtherPA BLUE SHIELD
PACE3282OtherRR MEDICARE
PA0010733600018Medicaid
PA=========OtherCOMMERCIAL
PA02790500OtherCAPITAL BLUE CROSS
PA1290510001Medicare NSC