Provider Demographics
NPI:1265468318
Name:BRANDES, MELISSA K (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:BRANDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SO WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-860-1441
Mailing Address - Fax:802-860-4646
Practice Address - Street 1:28 SO WILLIAMS 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:802-860-1441
Practice Address - Fax:802-860-4646
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2388Medicaid
VN238801OtherPTAN
VTH24455Medicare UPIN