Provider Demographics
NPI:1689962581
Name:SOULE', BRANDON (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:SOULE'
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-0051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 51
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-0051
Practice Address - Country:US
Practice Address - Phone:410-209-4428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11589363AM0700X
MTMED-PAC-LIC-120244363AM0700X
NC0010-13403363AM0700X
NMPA2024-0100363AM0700X
NY032841363AM0700X
OH50.008588RX363AM0700X
RIPA01767363AM0700X
DCPA031050363AM0700X
TN5516363AM0700X
TXPA17498363AM0700X
VA0110003650363AM0700X
FLPA9117365363AM0700X
MDC004461363AM0700X
CT6134363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQW258OtherHFMG MA