1386682425 NPI number — GORDON P BRAUN PA-C

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386682425 NPI number — GORDON P BRAUN PA-C

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BRAUN

Provider First Name:

GORDON

Provider Middle Name:

P

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

PA-C

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1386682425

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/07/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

785 5TH AVENUE

Provider Second Line Business Mailing Address:

SUITE 3

Provider Business Mailing Address City Name:

CHAMBERSBURG

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

17201-4232

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

717-263-9555

Provider Business Mailing Address Fax Number:

717-217-4218

Provider First Line Business Practice Location Address:

1000 NORLAND AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CHAMBERSBURG

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

17201-4229

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

717-267-6363

Provider Business Practice Location Address Fax Number:

717-217-6937

Provider Enumeration Date:

06/02/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 363AM0700X , with the licence number:  MA003092L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 25-1716306 . This is a "DEVON" identifier . This identifiers is of the category "OTHER".
• Identifier: 50094063 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 25-1716306 . This is a "PHCS/MULTIPLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 867633 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 103149700 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1386682425 . This is a "HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 25-1716306 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 626766 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 25-1716306 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 25-1716306 . This is a "INTERGROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 25-1716306 . This is a "INFORMED" identifier . This identifiers is of the category "OTHER".
• Identifier: MA003092L . This is a "LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".