Provider Demographics
NPI:1588645782
Name:KAREN GAIL BRANDSE MD & ASSOC
Entity Type:Organization
Organization Name:KAREN GAIL BRANDSE MD & ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:BRANDSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-650-7640
Mailing Address - Street 1:460 TOTTEN POND RD
Mailing Address - Street 2:C O MZI
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1906
Mailing Address - Country:US
Mailing Address - Phone:781-890-9933
Mailing Address - Fax:781-890-9950
Practice Address - Street 1:67 UNION ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:508-650-7640
Practice Address - Fax:508-650-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153726207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA66912OtherHPHC
MA9713671Medicaid
MAM18407OtherBCBS
MA691581OtherTUFTS
MA9713671Medicaid