1376860684 NPI number — DR. BRANDON R DEARMAN M.D.

Table of content: DR. BRANDON R DEARMAN M.D. (NPI 1376860684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376860684 NPI number — DR. BRANDON R DEARMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEARMAN
Provider First Name:
BRANDON
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1376860684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5070 RITTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MECHANICSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17055-4879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-272-6621
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5070 RITTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MECHANICSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17055-4879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-272-6621
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2010

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: 207Q00000X , with the licence number:  MD447271 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: MT196768 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 30159651 . This is a "AMERIHEALTH CARITAS-WMG - HFM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30159646 . This is a "AMERIHEALTH CARITAS-WMG - CE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 102826601 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30159656 . This is a "AMERIHEALTH CARITAS-WMG - WRC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2896639 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30125511 . This is a "AMERIHEALTH CARITAS-WMG - THFP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 789453 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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