Provider Demographics
NPI:1598788754
Name:BRAUNSTEIN, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BRAUNSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5000 VAN NUYS BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1717
Mailing Address - Country:US
Mailing Address - Phone:818-842-8202
Mailing Address - Fax:818-842-8202
Practice Address - Street 1:201 S BUENA VISTA ST
Practice Address - Street 2:SUITE 325
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4569
Practice Address - Country:US
Practice Address - Phone:818-842-8202
Practice Address - Fax:818-842-8202
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2016-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG64033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG64033Medicare ID - Type Unspecified
CAE60505Medicare UPIN