Provider Demographics
NPI:1932467404
Name:BRANDSTADTER, KAITLIN MOFFETT (MD)
Entity Type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:MOFFETT
Last Name:BRANDSTADTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAITLIN
Other - Middle Name:MOFFETT
Other - Last Name:RAWLUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD MPH
Mailing Address - Street 1:4865 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3508
Mailing Address - Country:US
Mailing Address - Phone:267-425-9800
Mailing Address - Fax:
Practice Address - Street 1:4865 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3508
Practice Address - Country:US
Practice Address - Phone:267-425-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC182235390200000X
PAMD454747208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program