Provider Demographics
NPI:1760451546
Name:BRANDT, CRAIG S (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:S
Last Name:BRANDT
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 1:1321 11TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-3301
Mailing Address - Country:US
Mailing Address - Phone:814-942-2411
Mailing Address - Fax:814-296-2040
Practice Address - Street 1:1321 11TH AVENUE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-3301
Practice Address - Country:US
Practice Address - Phone:814-942-2411
Practice Address - Fax:814-296-2040
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025805E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011237020013Medicaid
PA0105286OtherHIGHMARK
PA0011237020014Medicaid
PA105286WONMedicare PIN
PA105286ZC9XMedicare PIN
PA0011237020014Medicaid