Provider Demographics
NPI:1821046822
Name:BRANNICK, DENISE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:BRANNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 GENESEE ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-2199
Mailing Address - Country:US
Mailing Address - Phone:315-793-8806
Mailing Address - Fax:315-793-8046
Practice Address - Street 1:1500 N JAMES ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2844
Practice Address - Country:US
Practice Address - Phone:315-338-7029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1993172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY225083OtherMVP
NY01650540Medicaid
NY300083371OtherRAIL ROAD MEDICARE
NY01647929Medicaid
NY4102996OtherGHI
NY040426013911OtherFIDELIS
NY199317-9OtherWC
NY10045916OtherCDPHP
NYP010199317OtherBCBS
NY39162RMedicare ID - Type Unspecified
G24973Medicare UPIN
NYCC9088Medicare ID - Type Unspecified
300083371Medicare PIN