Provider Demographics
NPI:1548432933
Name:BRANDON, KIRRA L (MD)
Entity Type:Individual
Prefix:MRS
First Name:KIRRA
Middle Name:L
Last Name:BRANDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:403 MARVEL CT
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-4053
Mailing Address - Country:US
Mailing Address - Phone:410-819-8867
Mailing Address - Fax:410-822-0216
Practice Address - Street 1:403 MARVEL CT
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-4053
Practice Address - Country:US
Practice Address - Phone:410-819-8867
Practice Address - Fax:410-822-0416
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2962208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB104205Medicare PIN
MD683MMedicare PIN