Provider Demographics
NPI:1770562548
Name:BRANDON, WILLIAM ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:BRANDON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:110 WEST SQUANTUM ST.
Mailing Address - Street 2:BUSINESS OFFICE
Mailing Address - City:NORTH QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171
Mailing Address - Country:US
Mailing Address - Phone:617-376-3000
Mailing Address - Fax:617-774-1905
Practice Address - Street 1:MANET COMMUNITY HEALTH CENTER
Practice Address - Street 2:1 WASHINGTON ST.
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780
Practice Address - Country:US
Practice Address - Phone:617-376-3000
Practice Address - Fax:617-774-1905
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH14830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30209657Medicaid
ME435937299Medicaid
MAF38845Medicare UPIN
MEA3602002Medicare PIN
NH30209657Medicaid
NHA3602001Medicare PIN