Healthcare Provider Details

I. General information

NPI: 1437293073
Provider Name (Legal Business Name): DAWN M BRANNAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E UNIVERSITY PKWY
BALTIMORE MD
21218-2829
US

IV. Provider business mailing address

1000 RIVER RD STE 100
CONSHOHOCKEN PA
19428-2439
US

V. Phone/Fax

Practice location:
  • Phone: 410-554-2000
  • Fax:
Mailing address:
  • Phone: 800-355-3818
  • Fax: 610-834-2862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0003001
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: