MEDICARE: MR. JAMES MICHAEL BRAMBLE MA LPA HSP

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
1	103T00000X	Psychologist	565	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1353R	OTHER	NC	BC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	192726	OTHER	NC	MEDCOST
4	795356000	OTHER	NC	MAGELLAN
5	204836986	OTHER	NC	TRICARE

General Provider Information

NPI Number	:	1174584015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES MICHAEL BRAMBLE MA LPA HSP

Provider Business Mailing Address
First Line	:	1822 S GLENBURNIE RD STE 6
Second Line	:	PMB 147
City	:	NEW BERN
State	:	NC
Zip	:	28562-5221
Country	:	US
Telephone Number	:	252-638-8249
Fax Number	:	252-638-8248

Provider Business Practice Location Address
First Line	:	2002 S GLENBURNIE RD
Second Line	:	UNIT D-5
City	:	NEW BERN
State	:	NC
Zip	:	28562-5229
Country	:	US
Telephone Number	:	252-638-8249
Fax Number	:	252-638-8248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	10/31/2011

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