Provider Demographics
NPI:1689832776
Name:JOHN F. BRABAZON
Entity Type:Organization
Organization Name:JOHN F. BRABAZON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRABAZON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-733-2324
Mailing Address - Street 1:222 W FULTON ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1901
Mailing Address - Country:US
Mailing Address - Phone:717-733-2324
Mailing Address - Fax:717-733-6349
Practice Address - Street 1:222 W FULTON ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1901
Practice Address - Country:US
Practice Address - Phone:717-733-2324
Practice Address - Fax:717-733-6349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004376L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB40521Medicare UPIN
PA166085Medicare PIN