William P Braun III, MD, L AC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD030209E Issued in PA

Practice address

1440 Fox Gap Rd
Bangor, PA 18013-6008

Phone

(570) 702-4278

NPI assigned

May 23, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639612800000",
    "number": "1033164686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 485",
            "city": "MOUNT BETHEL",
            "state": "PA",
            "postal_code": "183430485",
            "telephone_number": "570-702-4278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 FOX GAP RD",
            "city": "BANGOR",
            "state": "PA",
            "postal_code": "180136008",
            "telephone_number": "570-702-4278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAUN",
        "first_name": "WILLIAM",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD, L AC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "PA",
            "license": "AK000136L",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA04249800",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD030209E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1279105",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00991908",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Colleen Berlen
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• Eric Black, LSW
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• Blue Valley Vision LLC
• Concetta L Brown, CRNP
• Timothy J Burt, M.S.
• Carol Ann Campbell, COTA
• Maria Rachelle Canchela, P.T.
• Janessa Capozzolo, CFO

• Family Medicine Physician in Bangor, PA
• Providers in Bangor, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.