Provider Demographics
NPI:1316976780
Name:BRANDON, NEIL (MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:BRANDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:70 KENYON AVE
Mailing Address - Street 2:SUITE 321
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-4239
Mailing Address - Country:US
Mailing Address - Phone:401-789-5770
Mailing Address - Fax:401-782-8530
Practice Address - Street 1:70 KENYON AVE
Practice Address - Street 2:SUITE 321
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4239
Practice Address - Country:US
Practice Address - Phone:401-789-5770
Practice Address - Fax:401-782-8530
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD07741207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7001693Medicaid
RIF01202Medicare UPIN
RI7001693Medicaid