Provider Demographics
NPI:1811099096
Name:BRANTLEY, WALEED A (MD)
Entity type:Individual
Prefix:DR
First Name:WALEED
Middle Name:A
Last Name:BRANTLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WALEED
Other - Middle Name:A
Other - Last Name:SALEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2223 WEST STATE ST
Mailing Address - Street 2:STE 109
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760
Mailing Address - Country:US
Mailing Address - Phone:716-373-0315
Mailing Address - Fax:716-373-2114
Practice Address - Street 1:2223 WEST STATE ST
Practice Address - Street 2:STE 109
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760
Practice Address - Country:US
Practice Address - Phone:716-373-0315
Practice Address - Fax:716-373-2114
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1302671207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020305101OtherUNIVERA
NY00798307Medicaid
NY000500192001OtherBCBS
NY00798307Medicaid
NY00020305101OtherUNIVERA