Provider Demographics
NPI:1265446454
Name:BRANDES, THOMAS A (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:BRANDES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9075 NEW ENGLAND RD
Mailing Address - Street 2:
Mailing Address - City:STEWART
Mailing Address - State:OH
Mailing Address - Zip Code:45778-9541
Mailing Address - Country:US
Mailing Address - Phone:740-541-0985
Mailing Address - Fax:
Practice Address - Street 1:401 MATTHEW ST
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1635
Practice Address - Country:US
Practice Address - Phone:740-376-1939
Practice Address - Fax:740-374-1693
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.006958207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9802052000Medicaid
OH2117364Medicaid
OH2117364Medicaid
OHH456940Medicare PIN
OH0892803Medicare PIN