Healthcare Provider Details

I. General information

NPI: 1477817302
Provider Name (Legal Business Name): BRANDEN MCCALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E 6TH ST
ERIE PA
16501-1201
US

IV. Provider business mailing address

PO BOX 1506
ERIE PA
16507-0506
US

V. Phone/Fax

Practice location:
  • Phone: 814-459-2755
  • Fax:
Mailing address:
  • Phone: 814-459-2755
  • Fax: 814-456-4873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: