Provider Demographics
NPI:1376565598
Name:OFFORD, BRENDA (PA-C)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:OFFORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:JASPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5171 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2215
Mailing Address - Country:US
Mailing Address - Phone:412-683-4550
Mailing Address - Fax:412-246-4567
Practice Address - Street 1:5171 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2215
Practice Address - Country:US
Practice Address - Phone:412-683-4550
Practice Address - Fax:412-683-8154
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000948L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA028023Medicare ID - Type Unspecified
PAS82145Medicare UPIN