Provider Demographics
NPI:1841279346
Name:BREIN, KENNETH ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ROBERT
Last Name:BREIN
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 1:1945 QUEENSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4254
Mailing Address - Country:US
Mailing Address - Phone:717-846-6900
Mailing Address - Fax:717-854-9728
Practice Address - Street 1:1945 QUEENSWOOD DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4254
Practice Address - Country:US
Practice Address - Phone:717-846-6900
Practice Address - Fax:717-854-9728
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029282E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011534340001Medicaid
PA121590GS5Medicare ID - Type UnspecifiedPERSONAL MEDICARE NUMBER
PA0011534340001Medicaid
PA199873Medicare ID - Type UnspecifiedPARTNERSHIP MEDICARE NO.
PA0912010001Medicare NSC