Organization
HR PHYSICIAN SERVICES
Active
Other names
Comprehensive Breast Care Surgeons
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL R WAGNER (CHIEF FINANCIAL OFFICER)
(215) 856-1114
Entity
Organization
Contact information
Practice address
45 SECOND STREET PIKE, SUITE 100, SOUTHAMPTON, PA 18966-3806
(215) 633-3456
(215) 245-5941
Mailing address
1648 HUNTINGDON PIKE, 1ST FLOOR BUSINESS OFFICE, MEADOWBROOK, PA 19046-8001
(215) 938-2040
(215) 938-2042
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015313400030
—
PA
Enumeration date
08/07/2007
Last updated
07/20/2012
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