Provider Demographics
NPI:1821266537
Name:BRECHBILL, IVAN T (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:T
Last Name:BRECHBILL
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 1:320 S CALLAHAN RD
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-7821
Mailing Address - Country:US
Mailing Address - Phone:570-724-3829
Mailing Address - Fax:
Practice Address - Street 1:320 S CALLAHAN RD
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-7821
Practice Address - Country:US
Practice Address - Phone:570-724-3829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA007666E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA106032Medicare PIN