Provider Demographics
NPI:1700463189
Name:BRANDEISMD
Entity Type:Organization
Organization Name:BRANDEISMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDSON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDEIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-255-7867
Mailing Address - Street 1:100 PARK PL STE 140
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4460
Mailing Address - Country:US
Mailing Address - Phone:925-255-7867
Mailing Address - Fax:
Practice Address - Street 1:100 PARK PL STE 140
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4460
Practice Address - Country:US
Practice Address - Phone:925-255-7867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty