Provider Demographics
NPI:1386682425
Name:BRAUN, GORDON P (PA-C)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:P
Last Name:BRAUN
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 1:785 5TH AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4218
Practice Address - Street 1:1000 NORLAND AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4229
Practice Address - Country:US
Practice Address - Phone:717-267-6363
Practice Address - Fax:717-217-6937
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003092L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
25-1716306OtherDEVON
PA50094063OtherCAPITAL BLUE CROSS
PA25-1716306OtherPHCS/MULTIPLAN
PA867633OtherMEDICARE GROUP #
PA103149700Medicaid
PA1386682425OtherHEALTH ASSURANCE
25-1716306OtherFIRST HEALTH
PA626766OtherAETNA
25-1716306OtherTRICARE
PA25-1716306OtherINTERGROUP
25-1716306OtherINFORMED
PAMA003092LOtherLICENSE
PAMA003092LOtherLICENSE
25-1716306OtherFIRST HEALTH
110425KBMMedicare PIN
PA25-1716306OtherPHCS/MULTIPLAN