Brandon Michael Goodlavage

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

RT007594 Issued in PA

Practice address

133 N River St
Wilkes Barre, PA 18711-0800

Phone

(570) 208-5900

NPI assigned

Sep 4, 2018

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• King'S College

  • Student Health Clinic/Center
  • Wilkes Barre, PA
  • NPI 1164749966
  NPD (past)

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

{
    "created_epoch": "1536019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712707200000",
    "number": "1417439779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 REID ST",
            "city": "PITTSTON",
            "state": "PA",
            "postal_code": "186403709",
            "telephone_number": "570-793-5032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 N RIVER ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187110800",
            "telephone_number": "570-208-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODLAVAGE",
        "first_name": "BRANDON",
        "middle_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-04",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT007594",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharon A Goldstein, RPH
• Anil K Gollapudi, M.D.
• Sruti S Golthi, DO
• Daniel Goltz, D.O
• April Dawn Gonzales
• Molly Goodman
• Goodwill Industries of NE PA
• Louise A Goodwin, MS, PT
• Megan Gordon
• Richard John Gorgol

• Athletic Trainer in Wilkes Barre, PA
• Providers in Wilkes Barre, PA by specialty
• Athletic Trainer in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; 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.