Provider Demographics
NPI:1952460628
Name:BRYANT, LUKE (RVT)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:BRYANT
Suffix:
Gender:M
Credentials:RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WINTERBERRY LN
Mailing Address - Street 2:
Mailing Address - City:GIBBSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08026-1509
Mailing Address - Country:US
Mailing Address - Phone:800-434-6070
Mailing Address - Fax:215-467-9110
Practice Address - Street 1:2070 SPRINGDALE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003
Practice Address - Country:US
Practice Address - Phone:800-434-6070
Practice Address - Fax:856-751-1667
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XC2901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularCardiovascular Invasive Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA025012Medicare PIN
PA021708Medicare PIN