Provider Demographics
NPI:1740320092
Name:BRANDRIFF, TIMOTHY (PA)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:BRANDRIFF
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 HOLLY HILL LN FL 3
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6071
Mailing Address - Country:US
Mailing Address - Phone:203-869-5515
Mailing Address - Fax:203-869-5765
Practice Address - Street 1:81 HOLLY HILL LN FL 3
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6071
Practice Address - Country:US
Practice Address - Phone:203-869-5515
Practice Address - Fax:203-869-5765
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000913363A00000X
CT003346363AM0700X
NY017907363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q21445Medicare UPIN
082002GT6Medicare ID - Type Unspecified