Provider Demographics
NPI:1871716092
Name:EBERT, BRYAN (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:EBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 W CHESTER PIKE
Mailing Address - Street 2:BUILDING D, SUITE 120
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2329
Mailing Address - Country:US
Mailing Address - Phone:610-550-3000
Mailing Address - Fax:610-550-3079
Practice Address - Street 1:3805 W CHESTER PIKE
Practice Address - Street 2:BUILDING D, SUITE 120
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2329
Practice Address - Country:US
Practice Address - Phone:610-550-3000
Practice Address - Fax:610-550-3079
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235059-1207ZP0101X
NY235059207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology