Basic Information
| Provider Information | |||||||||
| NPI: | 1841279346 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BREIN | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1945 QUEENSWOOD DR | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174034254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178466900 | ||||||||
| FaxNumber: | 7178549728 | ||||||||
| Practice Location | |||||||||
| Address1: | 1945 QUEENSWOOD DR | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174034254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178466900 | ||||||||
| FaxNumber: | 7178549728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2006 | ||||||||
| LastUpdateDate: | 01/11/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MD029282E | PA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 0011534340001 | 05 | PA | MEDICAID |