Provider Demographics
NPI:1376276485
Name:BROKER,CRAMER & SWANSON ENT, PC
Entity Type:Organization
Organization Name:BROKER,CRAMER & SWANSON ENT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDERACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-415-1100
Mailing Address - Street 1:826 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4459
Mailing Address - Country:US
Mailing Address - Phone:610-415-1100
Mailing Address - Fax:610-415-1101
Practice Address - Street 1:5 S SUNNYBROOK RD STE 300
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3285
Practice Address - Country:US
Practice Address - Phone:610-415-1100
Practice Address - Fax:610-415-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017758550010Medicaid