Provider Demographics
NPI:1184726788
Name:BREECKER, STEVEN WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:WILLIAM
Last Name:BREECKER
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 1:1015 CHESTNUT ST.
Mailing Address - Street 2:SUITE 1518
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4315
Mailing Address - Country:US
Mailing Address - Phone:215-955-8706
Mailing Address - Fax:215-955-8509
Practice Address - Street 1:1015 CHESTNUT ST.
Practice Address - Street 2:SUITE 1518
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4315
Practice Address - Country:US
Practice Address - Phone:215-955-8706
Practice Address - Fax:215-955-8509
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-035802-E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA60015055OtherRAILROAD MEDICARE
PA0084886000OtherKEYSTONE HEALTH PLAN
PA155110OtherPA BLUE SHIELD
PA155110OtherPA BLUE SHIELD