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NPI Code Detail

MEDICARE: BRANDON WHITE PA

MEDICARE: BRANDON WHITE PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant034168-01NY

General Provider Information

NPI Number : 1164318135
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON WHITE PA
Provider Business Mailing Address
First Line : 595 5TH AVE
Second Line :
City : TROY
State : NY
Zip : 12182-2501
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 595 5TH AVE
Second Line :
City : TROY
State : NY
Zip : 12182-2501
Country : US
Telephone Number : 518-262-5521
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2025
Last Update Date : 08/19/2025

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Directions to “ BRANDON WHITE PA” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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