Provider Demographics
NPI:1083844393
Name:BRANT, MARISA LORA (MD)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:LORA
Last Name:BRANT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:34TH ST. & CIVIC CENTER BLVD.
Mailing Address - Street 2:DIVISION OF NEONATOLOGY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4399
Mailing Address - Country:US
Mailing Address - Phone:215-590-2437
Mailing Address - Fax:215-590-2768
Practice Address - Street 1:34TH ST. & CIVIC CENTER BLVD.
Practice Address - Street 2:DIVISION OF NEONATOLOGY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4399
Practice Address - Country:US
Practice Address - Phone:215-590-2437
Practice Address - Fax:215-590-2768
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2014-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT1954102080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine