Provider Demographics
NPI:1649223827
Name:GREGORY A BRANDENBERG MD, PHD, INC
Entity Type:Organization
Organization Name:GREGORY A BRANDENBERG MD, PHD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BRANDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:937-299-8242
Mailing Address - Street 1:3533 SOUTHERN BLVD
Mailing Address - Street 2:STE 3000
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1280
Mailing Address - Country:US
Mailing Address - Phone:937-229-8242
Mailing Address - Fax:937-229-8245
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:STE 3000
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1280
Practice Address - Country:US
Practice Address - Phone:937-229-8242
Practice Address - Fax:937-229-8245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHGR9360841Medicare PIN