Provider Demographics
NPI:1225289168
Name:MCDUFFIE, BRANDON CARTER (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:CARTER
Last Name:MCDUFFIE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 MAIN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3301
Mailing Address - Country:US
Mailing Address - Phone:978-371-7010
Mailing Address - Fax:978-371-0522
Practice Address - Street 1:87 MCGREGOR ST STE 2100
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3767
Practice Address - Country:US
Practice Address - Phone:603-626-7546
Practice Address - Fax:603-626-7548
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1918363A00000X
FLPA9104516363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016128300Medicaid