Provider Demographics
NPI:1033164686
Name:BRAUN, WILLIAM P III (MD, L AC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:P
Last Name:BRAUN
Suffix:III
Gender:M
Credentials:MD, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:MOUNT BETHEL
Mailing Address - State:PA
Mailing Address - Zip Code:18343-0485
Mailing Address - Country:US
Mailing Address - Phone:570-702-4278
Mailing Address - Fax:
Practice Address - Street 1:1440 FOX GAP RD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-6008
Practice Address - Country:US
Practice Address - Phone:570-702-4278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000136L171100000X
NJ25MA04249800207Q00000X
PAMD030209E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1279105Medicaid
PA00991908Medicaid
NJ1279105Medicaid
NJ167189Medicare PIN
PA167189Medicare PIN