Provider Demographics
NPI:1790814168
Name:HARRADINE, BRANT PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANT
Middle Name:PAUL
Last Name:HARRADINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:16 DILLON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-4427
Mailing Address - Country:US
Mailing Address - Phone:631-764-2056
Mailing Address - Fax:
Practice Address - Street 1:400 PARNASSUS AVE FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2202
Practice Address - Country:US
Practice Address - Phone:415-353-2808
Practice Address - Fax:415-353-2956
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA98648207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery