Provider Demographics
NPI:1093798340
Name:BRANSON, DONALD G (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:G
Last Name:BRANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2137 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-6803
Mailing Address - Country:US
Mailing Address - Phone:434-385-4184
Mailing Address - Fax:434-385-8616
Practice Address - Street 1:2137 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6803
Practice Address - Country:US
Practice Address - Phone:434-385-4184
Practice Address - Fax:434-385-8616
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101016834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5627699Medicaid
VAB07051Medicare UPIN