Provider Demographics
NPI:1043302979
Name:BRANDA, RICHARD FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FRANK
Last Name:BRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482
Mailing Address - Country:US
Mailing Address - Phone:802-985-2625
Mailing Address - Fax:
Practice Address - Street 1:1 S. PROSPECT ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-847-3827
Practice Address - Fax:802-847-3510
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0006944207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00776958Medicaid
VT0005596Medicaid
VT0005596Medicaid
BRVT5596Medicare ID - Type Unspecified