Provider Demographics
NPI:1730726456
Name:BRAUCH, PHILLIP (PA)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:BRAUCH
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 1:24 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:WEST LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03784-1663
Mailing Address - Country:US
Mailing Address - Phone:603-298-6617
Mailing Address - Fax:
Practice Address - Street 1:7 WOODMORE DR
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-1320
Practice Address - Country:US
Practice Address - Phone:603-667-1426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-01
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program