Provider Demographics
NPI:1649557711
Name:BOWERS, BRANDON HARRISON (PA)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:HARRISON
Last Name:BOWERS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:BRANDON
Other - Middle Name:H
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:26 WINE ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-3584
Mailing Address - Country:US
Mailing Address - Phone:757-728-1100
Mailing Address - Fax:757-728-0870
Practice Address - Street 1:26 WINE ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-3584
Practice Address - Country:US
Practice Address - Phone:757-728-1100
Practice Address - Fax:757-728-0870
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003667363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant