Healthcare Provider Details

I. General information

NPI: 1679203467
Provider Name (Legal Business Name): BRANDON HAMM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 W 5TH AVE STE 225
COLUMBUS OH
43204-4899
US

IV. Provider business mailing address

5501 OLD YORK RD STE 1
PHILADELPHIA PA
19141-3098
US

V. Phone/Fax

Practice location:
  • Phone: 614-224-6420
  • Fax:
Mailing address:
  • Phone: 215-456-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOT021928
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: