Provider Demographics
NPI:1912903022
Name:BRANTZ, RICHARD MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MICHAEL
Last Name:BRANTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 E HUNTING PARK AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-4800
Mailing Address - Country:US
Mailing Address - Phone:215-535-4494
Mailing Address - Fax:215-535-4203
Practice Address - Street 1:841 E HUNTING PARK AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-4800
Practice Address - Country:US
Practice Address - Phone:215-535-4494
Practice Address - Fax:215-535-4203
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003987L207Q00000X
PA193400000X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6128979OtherCIGNA
PA00712055Medicaid
PA1003858OtherKEYSTINE MERCY
PA00712055OtherAMERICHOICE
PA00422OtherHEALTH PARTNERS
PA0018074OtherAETNA
PA165550OtherBLUE SHIELD
PAPA10426OtherELDER HEALTH
PA165550Medicare ID - Type Unspecified
PA6128979OtherCIGNA
NJ0000055195Medicare ID - Type Unspecified