Organization
DOUGLAS J. BRUNNER, M. D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS J. BRUNNER MD (MD)
(610) 595-6521
Entity
Organization
Contact information
Practice address
175 E CHESTER PIKE, RIDLEY PARK, PA 19078-2212
(610) 595-6542
(610) 595-6077
Mailing address
175 E CHESTER PIKE, RIDLEY PARK, PA 19078-2212
(610) 595-6521
(610) 595-6077
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD027564E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009930450002
—
PA
01
—
0099162
AETNA USHC
PA
01
—
0142329000
IBC KEYSTONE/PERS CHOICE
PA
01
—
30018109
KEYSTONE MERCY
PA
01
—
884151
HIGHMARK BLUE SHIELD
PA
01
—
DA5481
TRAVELERS MEDICARE
PA
Enumeration date
02/09/2007
Last updated
10/15/2007
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