Provider Demographics
NPI:1417059908
Name:BRACKUP, ALAN BART (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:BART
Last Name:BRACKUP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 LANGHORNE NEWTOWN RD
Mailing Address - Street 2:STE 150
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1089
Mailing Address - Country:US
Mailing Address - Phone:215-750-9400
Mailing Address - Fax:215-750-7400
Practice Address - Street 1:1717 LANGHORNE NEWTOWN RD STE 150
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1089
Practice Address - Country:US
Practice Address - Phone:215-750-9400
Practice Address - Fax:215-750-7400
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044284E174400000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0342693000OtherKEYSTONE
PA4122424OtherAETNA PPO
PA0790237OtherCIGNA
PA520626OtherPERSONAL CHOICE
PA0520626OtherPABS (HIGHMARK)
PA2265859OtherAETNA HMO
PAE20626OtherAMERIHEALTH
PA4122424OtherAETNA PPO
A03683Medicare UPIN