Provider Demographics
NPI:1770564528
Name:BRANDON, THOMAS ALBERT (MD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ALBERT
Last Name:BRANDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4B SKIDAWAY VILLAGE WALK
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31411
Mailing Address - Country:US
Mailing Address - Phone:912-598-6312
Mailing Address - Fax:912-809-4995
Practice Address - Street 1:4B SKIDAWAY VILLAGE WALK
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31411
Practice Address - Country:US
Practice Address - Phone:912-598-6312
Practice Address - Fax:912-809-4995
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38138207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000258401Medicaid
MD22859OtherMDIPA OPTIMUM CHOICE
3226811OtherAETNA
MD38138OtherFREESTATE DELMARVA HEALTH
200022315OtherRAILROAD MEDICARE
52782201H524PEOtherTRIGON BCBS
0004W409OtherBCBS PROD FEP BLUE CHOICE
327279OtherPRIME HEALTH
221921800OtherUS DEPARTMENT OF LABOR
VA006440410Medicaid
MD550671900Medicaid
66G42OtherEMPIRE BCBS
VA091051OtherTRIGON BCBS
MDC82944Medicare UPIN
MD550671900Medicaid