Provider Demographics
NPI:1962490714
Name:BRANT, PAUL DENNIS (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DENNIS
Last Name:BRANT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 RACE ST
Mailing Address - Street 2:P.O. BOX 976
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1835
Mailing Address - Country:US
Mailing Address - Phone:410-228-0500
Mailing Address - Fax:410-228-0504
Practice Address - Street 1:401 RACE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1835
Practice Address - Country:US
Practice Address - Phone:410-228-0500
Practice Address - Fax:410-228-0504
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTAO742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6902000000Z671OtherCARE FIRST
MD4379297OtherAETNA
MD771378900Medicaid
MD21434OtherMDIPA/MAMSI
T60006Medicare UPIN
MD4379297OtherAETNA