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NPI Code Detail

MEDICARE: BRANDI RAE SENIOR PA-C

MEDICARE: BRANDI RAE SENIOR PA-C
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
1363AM0700XMedical Physician AssistantC0004239MD

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01658288OTHERMDRR MEDICARE

General Provider Information

NPI Number : 1346415890
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDI RAE SENIOR PA-C
Provider Business Mailing Address
First Line : 7250 PARKWAY DR
Second Line : STE 500
City : HANOVER
State : MD
Zip : 21076-1343
Country : US
Telephone Number : 443-949-0814
Fax Number : 443-949-0814
Provider Business Practice Location Address
First Line : 16 N LA PLATA CT
Second Line :
City : LA PLATA
State : MD
Zip : 20646-4283
Country : US
Telephone Number : 301-392-3330
Fax Number : 301-392-3950
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2008
Last Update Date : 08/08/2017

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Directions to “ BRANDI RAE SENIOR PA-C” Practice Location

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