Basic Information
| Provider Information | |||||||||
| NPI: | 1386682425 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAUN | ||||||||
| FirstName: | GORDON | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVENUE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174218 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 NORLAND AVE | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172676363 | ||||||||
| FaxNumber: | 7172176937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 10/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA003092L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 25-1716306 | 01 | DEVON | OTHER | 50094063 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 25-1716306 | 01 | PA | PHCS/MULTIPLAN | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | 103149700 | 05 | PA | MEDICAID | 1386682425 | 01 | PA | HEALTH ASSURANCE | OTHER | 25-1716306 | 01 | FIRST HEALTH | OTHER | 626766 | 01 | PA | AETNA | OTHER | 25-1716306 | 01 | TRICARE | OTHER | MB2728105 | 01 | PA | PA DEA | OTHER | 25-1716306 | 01 | PA | INTERGROUP | OTHER | 25-1716306 | 01 | INFORMED | OTHER | MA003092L | 01 | PA | LICENSE | OTHER |