Provider Demographics
NPI:1801976238
Name:BRANDT, MARY (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BRANDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 TULANE AVE
Mailing Address - Street 2:# 8622
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2632
Mailing Address - Country:US
Mailing Address - Phone:832-822-3135
Mailing Address - Fax:832-825-3141
Practice Address - Street 1:200 HENRY CLAY AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5798
Practice Address - Country:US
Practice Address - Phone:504-899-9511
Practice Address - Fax:832-825-3141
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG67052086S0120X
LA3238412086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138656704Medicaid
TX138656707Medicaid
TX138656708Medicaid
88H518Medicare PIN
E45812Medicare UPIN
TX8L1520Medicare PIN
TXTXB117074Medicare PIN
81Z722Medicare PIN