Provider Demographics
NPI:1194712497
Name:JARRAH BRANTON, LORRAINE (MD)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:
Last Name:JARRAH BRANTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LORRAINE
Other - Middle Name:FAY
Other - Last Name:JARRAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:26248 KENSINGTON LN
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-2338
Mailing Address - Country:US
Mailing Address - Phone:410-548-1593
Mailing Address - Fax:
Practice Address - Street 1:1205 PEMBERTON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-2483
Practice Address - Country:US
Practice Address - Phone:410-546-5141
Practice Address - Fax:410-548-7574
Is Sole Proprietor?:No
Enumeration Date:2005-10-02
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050614207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG28192Medicare UPIN