Provider Demographics
NPI:1821036773
Name:BROWNSTEIN, BRUCE KEITH (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:KEITH
Last Name:BROWNSTEIN
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 1:1 PENN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-1476
Mailing Address - Country:US
Mailing Address - Phone:215-438-2020
Mailing Address - Fax:215-951-8985
Practice Address - Street 1:1 PENN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1476
Practice Address - Country:US
Practice Address - Phone:215-438-2020
Practice Address - Fax:215-951-8985
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD020980E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0053126000OtherIBX HMO IDENTIFIER
PA188469Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
PA0053126000OtherIBX HMO IDENTIFIER
PAB34075Medicare UPIN