Provider Demographics
NPI:1124061171
Name:BRANDT, THOMAS D (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:BRANDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 NAZARETH RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-8338
Mailing Address - Country:US
Mailing Address - Phone:610-252-6243
Mailing Address - Fax:610-252-8614
Practice Address - Street 1:3735 NAZARETH RD
Practice Address - Street 2:SUITE 206
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8338
Practice Address - Country:US
Practice Address - Phone:610-252-6243
Practice Address - Fax:610-252-8614
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061639L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03056012Medicaid
C42177Medicare UPIN
PA901654Medicare ID - Type Unspecified