Individual
DEAN M BROCKMOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4518 UNION DEPOSIT RD, HARRISBURG, PA 17111-2921
(717) 652-5840
(717) 652-8152
Mailing address
4520 UNION DEPOSIT RD, HARRISBURG, PA 17111-2910
(717) 652-6105
(717) 652-2165
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD037953E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011093380001
—
PA
05
—
0011093380015
—
PA
05
—
0011093380020
—
PA
05
—
0011093380022
—
PA
05
—
0011093380023
—
PA
01
—
300057799
RAILROAD MEDICARE
PA
Enumeration date
08/30/2005
Last updated
01/24/2008
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