Healthcare Provider Details

I. General information

NPI: 1245813542
Provider Name (Legal Business Name): BRIAN VAN DAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S GEORGE ST
YORK PA
17403-3676
US

IV. Provider business mailing address

100 FODEN RD STE 103
SOUTH PORTLAND ME
04106-2327
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-2311
  • Fax:
Mailing address:
  • Phone: 207-828-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD29127
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMT222617
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: