Provider Demographics
NPI:1174728802
Name:PENNSYLVANIA CENTRE FOR PLASTIC SURGERY, PC
Entity type:Organization
Organization Name:PENNSYLVANIA CENTRE FOR PLASTIC SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BRENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-829-7290
Mailing Address - Street 1:800 SPRUCE ST
Mailing Address - Street 2:10TH FLOOR, SPRUCE BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6130
Mailing Address - Country:US
Mailing Address - Phone:215-829-7290
Mailing Address - Fax:215-829-5430
Practice Address - Street 1:800 SPRUCE ST
Practice Address - Street 2:10TH FLOOR, SPRUCE BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6130
Practice Address - Country:US
Practice Address - Phone:215-829-7290
Practice Address - Fax:215-829-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028290E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0608329OtherAETNA
PA0413987OtherHIGHMARK BLUE SHIELD
PA0181250000OtherIBC
PA0608329OtherAETNA
PA0413987OtherHIGHMARK BLUE SHIELD