MEDICARE: BRANNING PODIATRY, PC

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	213ES0103X	Foot & Ankle Surgery Podiatrist	SC005984	PA

General Provider Information

NPI Number	:	1417393000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANNING PODIATRY, PC

Provider Business Mailing Address
First Line	:	310 SUNRISE AVE
Second Line	:	SUITE B
City	:	HONESDALE
State	:	PA
Zip	:	18431-0509
Country	:	US
Telephone Number	:	570-352-3668
Fax Number	:	570-352-3669

Provider Business Practice Location Address
First Line	:	310 SUNRISE AVE
Second Line	:	SUITE B
City	:	HONESDALE
State	:	PA
Zip	:	18431-1032
Country	:	US
Telephone Number	:	570-352-3668
Fax Number	:	570-352-3669

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NICOLE MARIE BRANNING
Credential	:	DPM
Telephone Number	:	570-352-3668

Provider Enumeration Date	:	05/22/2013
Last Update Date	:	05/22/2013

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