Provider Demographics
NPI:1285191874
Name:CODDINGTON, BRANDON P
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:P
Last Name:CODDINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 OVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:WEST HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120-1311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1618 OVERDALE DR
Practice Address - Street 2:
Practice Address - City:WEST HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1311
Practice Address - Country:US
Practice Address - Phone:412-297-6547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty