Provider Demographics
NPI:1710270731
Name:BENTLEY, BRIAN SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:SCOTT
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 UNION DEPOSIT RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111
Mailing Address - Country:US
Mailing Address - Phone:717-652-6105
Mailing Address - Fax:717-652-2165
Practice Address - Street 1:4518 UNION DEPOSIT RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111
Practice Address - Country:US
Practice Address - Phone:717-652-5840
Practice Address - Fax:717-652-8152
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT0142032085R0202X
PAOS0179062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology