Individual
MR. ERIC LANCE BRANDENBURG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
905 VERDAE BLVD STE 101, GREENVILLE, SC 29607-4098
(864) 286-7550
(864) 286-7551
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
020218
NY
363A00000X
Physician Assistant
Primary
4258
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6063PA
—
SC
Enumeration date
09/28/2016
Last updated
12/21/2023
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