Provider Demographics
NPI:1306883780
Name:BREAST CARE SPECIALISTS, P.C.
Entity type:Organization
Organization Name:BREAST CARE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-366-7333
Mailing Address - Street 1:250 CETRONIA ROAD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5052
Mailing Address - Country:US
Mailing Address - Phone:610-366-7333
Mailing Address - Fax:610-366-7334
Practice Address - Street 1:250 CETRONIA ROAD
Practice Address - Street 2:SUITE 302
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5052
Practice Address - Country:US
Practice Address - Phone:610-366-7333
Practice Address - Fax:610-366-7334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA057650Medicare ID - Type Unspecified