Provider Demographics
NPI:1568971026
Name:FORDHAM, BRANDON JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:JAMES
Last Name:FORDHAM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:60 COMMERCE PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7386
Mailing Address - Country:US
Mailing Address - Phone:910-521-2900
Mailing Address - Fax:910-775-9165
Practice Address - Street 1:128 E BROAD ST
Practice Address - Street 2:
Practice Address - City:SAINT PAULS
Practice Address - State:NC
Practice Address - Zip Code:28384-1610
Practice Address - Country:US
Practice Address - Phone:910-241-3042
Practice Address - Fax:910-241-3462
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2022-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-07597363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant