Provider Demographics
NPI:1558347005
Name:BRANDITZ, FRED K (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:K
Last Name:BRANDITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 BETHESDA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1880
Mailing Address - Country:US
Mailing Address - Phone:740-454-4788
Mailing Address - Fax:
Practice Address - Street 1:751 FOREST AVE STE 400
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2875
Practice Address - Country:US
Practice Address - Phone:740-586-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055322207R00000X
OH35-055322207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH110175445OtherMEDICARE RAILROAD
CA1586OtherGROUP MEDICARE RAILROAD
OH0669487Medicaid
OH0989499OtherGROUP MEDICAID
C33810Medicare UPIN
OH0989499OtherGROUP MEDICAID
CA1586OtherGROUP MEDICARE RAILROAD
OH0669487Medicaid