Healthcare Provider Details

I. General information

NPI: 1609856723
Provider Name (Legal Business Name): JASON H BRAJER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CORNERSTONE LN
BRYN MAWR PA
19010-2073
US

IV. Provider business mailing address

601 CORNERSTONE LANE
BRYN MAWR PA
19010-2073
US

V. Phone/Fax

Practice location:
  • Phone: 610-527-8820
  • Fax: 610-672-9722
Mailing address:
  • Phone: 610-527-8820
  • Fax: 610-672-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD025443E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD025443E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberC10008831
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD025443E
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD025443E
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberC10008831
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: