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NPI Code Detail

MEDICARE: BRANDON S HARK DO

MEDICARE: BRANDON S HARK DO
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
1390200000XStudent in an Organized Health Care Education/Training ProgramVA

General Provider Information

NPI Number : 1679035885
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON S HARK DO
Provider Business Mailing Address
First Line : 601 CHILDRENS LN
Second Line :
City : NORFOLK
State : VA
Zip : 23507-1971
Country : US
Telephone Number : 757-668-9982
Fax Number :
Provider Business Practice Location Address
First Line : 601 CHILDRENS LN
Second Line :
City : NORFOLK
State : VA
Zip : 23507-1971
Country : US
Telephone Number : 757-668-9982
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2019
Last Update Date : 04/05/2019

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Directions to “ BRANDON S HARK DO” Practice Location

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