Provider Demographics
NPI:1891313623
Name:BRANCH, CARLOS D
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:D
Last Name:BRANCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 WOODRUFF ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-3455
Mailing Address - Country:US
Mailing Address - Phone:757-292-5878
Mailing Address - Fax:
Practice Address - Street 1:426 WOODRUFF ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-3455
Practice Address - Country:US
Practice Address - Phone:757-292-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver