Provider Demographics
NPI:1528220829
Name:BREISH, CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:BREISH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:SUITE 467 LANKENAU MOB EAST
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-896-7424
Mailing Address - Fax:610-896-6171
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:SUITE 467 MOB EAST
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-896-7424
Practice Address - Fax:610-896-6171
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2015-02-05
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Provider Licenses
StateLicense IDTaxonomies
PAMD439955207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA217930HK1Medicare PIN