Provider Demographics
NPI:1861532210
Name:BARHAM, BRANDON MICHAEL (CPO)
Entity type:Individual
Prefix:MS
First Name:BRANDON
Middle Name:MICHAEL
Last Name:BARHAM
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:MR
Other - First Name:BRANDON
Other - Middle Name:M
Other - Last Name:BARHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPO
Mailing Address - Street 1:200 TIMBERHILL PLACE STE 203
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-0101
Mailing Address - Country:US
Mailing Address - Phone:919-945-0215
Mailing Address - Fax:919-945-0220
Practice Address - Street 1:200 TIMBERHILL PL STE 203
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1596
Practice Address - Country:US
Practice Address - Phone:919-945-0215
Practice Address - Fax:919-945-0220
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795376Medicaid