Provider Demographics
NPI:1801190731
Name:DENIS F BRANSON MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DENIS F BRANSON MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-446-8313
Mailing Address - Street 1:7000 E GENESEE ST
Mailing Address - Street 2:BUILDING E
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1131
Mailing Address - Country:US
Mailing Address - Phone:315-446-8313
Mailing Address - Fax:315-446-5387
Practice Address - Street 1:7000 E GENESEE ST
Practice Address - Street 2:BUILDING E
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1131
Practice Address - Country:US
Practice Address - Phone:315-446-8313
Practice Address - Fax:315-446-5387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162343208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070001967OtherPALMETTO GBA MEDICARE PR
NY50469BOtherMEDICARE ID-TYPE UNSPECIFIED
NY1612881118OtherTAX ID
NY50469BOtherMEDICARE ID-TYPE UNSPECIFIED