Provider Demographics
NPI:1699789693
Name:LANDRY & BRANDES MD'S PLC
Entity type:Organization
Organization Name:LANDRY & BRANDES MD'S PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MJ (MARY JANE)
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDUKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-860-3934
Mailing Address - Street 1:1205 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408-2751
Mailing Address - Country:US
Mailing Address - Phone:802-860-3934
Mailing Address - Fax:802-865-7616
Practice Address - Street 1:1205 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05408-2751
Practice Address - Country:US
Practice Address - Phone:802-860-3934
Practice Address - Fax:802-865-7616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009417Medicaid
VTVN3099Medicare PIN