=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992117006
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDON M. TAUBERG M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2014
-----------------------------------------------------
Last Update Date | 01/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 95 LEONARD AVE STE 500
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15301-3351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-705-8906
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 95 LEONARD AVE STE 500
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15301-3351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-705-8906
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | MT206221
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | MD474314
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------