Provider Demographics
NPI:1972507648
Name:BRERETON, HARMAR D (MD)
Entity Type:Individual
Prefix:
First Name:HARMAR
Middle Name:D
Last Name:BRERETON
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 1:712 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1094
Mailing Address - Country:US
Mailing Address - Phone:570-504-7210
Mailing Address - Fax:570-955-2213
Practice Address - Street 1:1110 MEADE ST
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-3169
Practice Address - Country:US
Practice Address - Phone:570-504-7200
Practice Address - Fax:570-504-7209
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027996-E174400000X
PAMD027996E2085R0001X
PAMD 027996E2085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1155655Medicaid
PA000878796Medicaid
NJ5189101Medicaid
P0029263Medicare PIN
NJ106451Medicare PIN
NJ5189101Medicaid
PA415400Medicare PIN
NY2580E1Medicare PIN