Provider Demographics
NPI:1275823973
Name:COLON AND RECTAL WELLNESS CENTER
Entity Type:Organization
Organization Name:COLON AND RECTAL WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-538-3330
Mailing Address - Street 1:157 GRISTMILL LN
Mailing Address - Street 2:
Mailing Address - City:ZELIENOPLE
Mailing Address - State:PA
Mailing Address - Zip Code:16063-3119
Mailing Address - Country:US
Mailing Address - Phone:724-538-3330
Mailing Address - Fax:
Practice Address - Street 1:105 BRANDT DR
Practice Address - Street 2:SUITE 202
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6437
Practice Address - Country:US
Practice Address - Phone:724-538-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031375E208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty