Provider Demographics
NPI:1972589901
Name:PAWLSON, BRENT DAVID (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:DAVID
Last Name:PAWLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-291-5931
Mailing Address - Fax:717-291-5818
Practice Address - Street 1:2106 HARRISBURG PIKE
Practice Address - Street 2:SUITE 1
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-291-5931
Practice Address - Fax:717-291-5818
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421527208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01969812Medicaid
PA01969812Medicaid
H94364Medicare UPIN