Healthcare Provider Details

I. General information

NPI: 1124026760
Provider Name (Legal Business Name): BRIAN J DAMWEBER MPAS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3477 CORPORATE PKWY STE 100
CENTER VALLEY PA
18034-8237
US

IV. Provider business mailing address

1 E BROAD ST STE 130
BETHLEHEM PA
18018-5934
US

V. Phone/Fax

Practice location:
  • Phone: 484-626-0480
  • Fax: 484-896-9002
Mailing address:
  • Phone: 484-626-0480
  • Fax: 484-896-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA002758L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: