Provider Demographics
NPI:1346415890
Name:SENIOR, BRANDI RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:RAE
Last Name:SENIOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7250 PARKWAY DR
Mailing Address - Street 2:STE 500
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1343
Mailing Address - Country:US
Mailing Address - Phone:443-949-0814
Mailing Address - Fax:443-949-0814
Practice Address - Street 1:16 N LA PLATA CT
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-4283
Practice Address - Country:US
Practice Address - Phone:301-392-3330
Practice Address - Fax:301-392-3950
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2017-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC0004239363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP01658288OtherRR MEDICARE
MD399210ZAQBMedicare PIN