Provider Demographics
NPI:1871510321
Name:BRANDT, ANDREAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREAS
Middle Name:M
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:PO BOX 17572
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1572
Mailing Address - Country:US
Mailing Address - Phone:866-916-5259
Mailing Address - Fax:231-922-4030
Practice Address - Street 1:411 W RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2938
Practice Address - Country:US
Practice Address - Phone:703-671-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76359207P00000X
LA10973R207P00000X
WV18603207P00000X
VA0101047573207P00000X
OK28048207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005633273Medicaid
WV0054665000Medicaid
VA005639298Medicaid
VA005639280Medicaid
VA005633257Medicaid
VA005640750Medicaid
VA005633257Medicaid
WV0054665000Medicaid
WVBR0815283Medicare PIN
VA012605V20Medicare PIN
VA930001290Medicare PIN
G12323Medicare UPIN
VA930001289Medicare PIN