Provider Demographics
NPI:1790045821
Name:LINGENFELTER, BRANDON M (DO)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:M
Last Name:LINGENFELTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 12TH STREET EXT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2300
Mailing Address - Country:US
Mailing Address - Phone:681-282-5591
Mailing Address - Fax:681-282-5593
Practice Address - Street 1:411 12TH STREET EXT
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2300
Practice Address - Country:US
Practice Address - Phone:681-282-5591
Practice Address - Fax:681-282-5593
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3064207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology