1578778676 NPI number — LANCE M BRUNTON MD

Table of content: LANCE M BRUNTON MD (NPI 1578778676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578778676 NPI number — LANCE M BRUNTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUNTON
Provider First Name:
LANCE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1578778676
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 JEFFERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEANNETTE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15644-2538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-527-8060
Provider Business Mailing Address Fax Number:
724-522-4002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8775 NORWIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N HUNTINGDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15642-2718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-861-7901
Provider Business Practice Location Address Fax Number:
724-861-7928
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  MD436094 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X , with the licence number: MD436094 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1023034770 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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