Provider Demographics
NPI:1962811497
Name:DOVERSPIKE, BRANDON (DO)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:DOVERSPIKE
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 1:210 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:16242-1226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 DOCTORS LN
Practice Address - Street 2:SUITE 202
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8568
Practice Address - Country:US
Practice Address - Phone:814-226-2500
Practice Address - Fax:814-226-2501
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT015723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine