Healthcare Provider Details

I. General information

NPI: 1720406861
Provider Name (Legal Business Name): COREY RAE MCBRAYER D.O. MPH CPPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KIMBERLY RAE MCBRAYER DO MPH CPPS

II. Dates (important events)

Enumeration Date: 04/05/2014
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 W GOVERNOR RD
HERSHEY PA
17033-2307
US

IV. Provider business mailing address

500 UNIVERSITY DR MC CA410
HERSHEY PA
17033-2360
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-7235
  • Fax: 717-531-0067
Mailing address:
  • Phone: 717-531-7235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberOS022892
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: