Provider Demographics
NPI:1437103694
Name:TORCATO, BRIAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:TORCATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:119 BLACK WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1948
Mailing Address - Country:US
Mailing Address - Phone:610-567-3857
Mailing Address - Fax:215-722-8022
Practice Address - Street 1:5900 RISING SUN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-1117
Practice Address - Country:US
Practice Address - Phone:215-722-2022
Practice Address - Fax:215-722-8022
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD059220L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01603171Medicaid
PAMDO59220LOtherMEDICAL LICENSE
G35589Medicare UPIN
PA01603171Medicaid