Provider Demographics
NPI:1417096769
Name:BRANHAM, LEANDER NIKIMA CRAGIN (MD)
Entity Type:Individual
Prefix:DR
First Name:LEANDER
Middle Name:NIKIMA CRAGIN
Last Name:BRANHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEANDER
Other - Middle Name:N
Other - Last Name:BLAKEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1384
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701
Mailing Address - Country:US
Mailing Address - Phone:508-877-8698
Mailing Address - Fax:
Practice Address - Street 1:1001 NORTH COUNTRY CLUB RD
Practice Address - Street 2:CARL ALBERT HOSPITAL I M DEPT
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820
Practice Address - Country:US
Practice Address - Phone:580-421-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80440207R00000X
SC20727207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F34829Medicare UPIN