Provider Demographics
NPI:1306969001
Name:COMPREHENSIVE BREAST CARE ASSOC PC
Entity type:Organization
Organization Name:COMPREHENSIVE BREAST CARE ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPREE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-633-3456
Mailing Address - Street 1:3300 TILLMAN DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020
Mailing Address - Country:US
Mailing Address - Phone:215-633-3456
Mailing Address - Fax:215-245-5941
Practice Address - Street 1:3300 TILLMAN DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020
Practice Address - Country:US
Practice Address - Phone:215-633-3456
Practice Address - Fax:215-245-5941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073497L208600000X
PAMD429193208600000X
PAMD042133E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH41720Medicare UPIN
PAF24036Medicare UPIN
049151Medicare PIN