Provider Demographics
NPI:1972906915
Name:BRANTLEY, JOHN (DR TAXATION)
Entity Type:Individual
Prefix:MRS
First Name:JOHN
Middle Name:
Last Name:BRANTLEY
Suffix:
Gender:M
Credentials:DR TAXATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1633
Mailing Address - Country:US
Mailing Address - Phone:410-662-5909
Mailing Address - Fax:
Practice Address - Street 1:1539 SHEFFIELD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-1633
Practice Address - Country:US
Practice Address - Phone:410-662-5909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-05
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251V00000X
MD03QY679390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program