Provider Demographics
NPI:1114557055
Name:BRAND, SAMUEL A (HIS)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:A
Last Name:BRAND
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:LUZERNE
Mailing Address - State:PA
Mailing Address - Zip Code:18709-1500
Mailing Address - Country:US
Mailing Address - Phone:570-262-9779
Mailing Address - Fax:
Practice Address - Street 1:365 BENNETT ST
Practice Address - Street 2:
Practice Address - City:LUZERNE
Practice Address - State:PA
Practice Address - Zip Code:18709-1500
Practice Address - Country:US
Practice Address - Phone:570-262-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03704237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty