Provider Demographics
NPI:1326008301
Name:HODGSON, BRANDY LEE (PAC)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:LEE
Last Name:HODGSON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:LEE
Other - Last Name:CRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4093
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:503 N 21ST ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2204
Practice Address - Country:US
Practice Address - Phone:717-972-4448
Practice Address - Fax:717-972-7366
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003641L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P56979Medicare UPIN
PA127794Medicare PIN