Provider Demographics
NPI:1891786802
Name:BRANDOFF, DOUGLAS EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:EVAN
Last Name:BRANDOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:44 BINNEY ST
Mailing Address - Street 2:DANA-FARBER CANCER INSTITUTE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6013
Mailing Address - Country:US
Mailing Address - Phone:617-632-6464
Mailing Address - Fax:617-632-6180
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:DANA-FARBER CANCER INSTITUTE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6013
Practice Address - Country:US
Practice Address - Phone:617-632-6464
Practice Address - Fax:617-632-6180
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2007-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA223968207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA468146OtherTUFTS HEALTH PLAN
MA2101084Medicaid
MAJ28577OtherBCBS OF MA
MA468146OtherTUFTS HEALTH PLAN
MAJ28577OtherBCBS OF MA