Provider Demographics
NPI:1396833463
Name:BALL, BRANDON M (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:M
Last Name:BALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:196 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-5537
Mailing Address - Country:US
Mailing Address - Phone:724-439-1020
Mailing Address - Fax:724-434-5485
Practice Address - Street 1:196 W MAIN ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-5537
Practice Address - Country:US
Practice Address - Phone:724-439-1020
Practice Address - Fax:724-434-5485
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073354L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01847480Medicaid
PA01847480Medicaid
PA118130Medicare PIN