Provider Demographics
NPI:1285983734
Name:MERRILL, BRANDON PATRICK (MD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:PATRICK
Last Name:MERRILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:950 N GLEBE RD STE 700
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-4173
Mailing Address - Country:US
Mailing Address - Phone:571-982-6636
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:410 CONNELL RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1898
Practice Address - Country:US
Practice Address - Phone:229-225-1900
Practice Address - Fax:229-225-3472
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2017012765207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology