Individual
ALBERT M BROENNLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
34TH STREET & CIVIC CENTER BLVD, SUITE 9329, PHILADELPHIA, PA 19104
(215) 590-1858
(215) 590-1415
Mailing address
100 N 20TH STREET, SUITE 200, PHILADELPHIA, PA 19103
(215) 977-8100
(215) 977-8351
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
MD014236E
PA
207LP3000X
Pediatric Anesthesiology Physician
Primary
MD014236E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006842280
—
PA
01
—
117999
MEDICARE ID
PA
Enumeration date
08/10/2006
Last updated
09/09/2009
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