Provider Demographics
NPI:1013595396
Name:TWOMBLY, BRANDON GREGORY (DO)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:GREGORY
Last Name:TWOMBLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 GREEN ST APT K
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-5010
Mailing Address - Country:US
Mailing Address - Phone:610-710-6172
Mailing Address - Fax:
Practice Address - Street 1:1260 E WOODLAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3956
Practice Address - Country:US
Practice Address - Phone:610-690-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS022995207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program