Provider Demographics
NPI:1255374906
Name:BRANDON, CHRISTOPHER ALLEN (PA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ALLEN
Last Name:BRANDON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E ANTIETAM ST
Mailing Address - Street 2:WASHINGTON COUNTY HOSPITAL ER
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5724
Mailing Address - Country:US
Mailing Address - Phone:301-790-8372
Mailing Address - Fax:301-790-8851
Practice Address - Street 1:251 E ANTIETAM ST
Practice Address - Street 2:WASHINGTON COUNTY HOSPITAL ER
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5724
Practice Address - Country:US
Practice Address - Phone:301-790-8372
Practice Address - Fax:301-790-8851
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009520363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q28943Medicare UPIN
NY5679L1Medicare ID - Type Unspecified
MD165681Y1ZMedicare PIN
MDP00779710Medicare PIN