Provider Demographics
NPI:1952367484
Name:WHITESIDE, BRANDON C (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:C
Last Name:WHITESIDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16610 BIRKDALE COMMONS PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5646
Mailing Address - Country:US
Mailing Address - Phone:704-895-8200
Mailing Address - Fax:
Practice Address - Street 1:16610 BIRKDALE COMMONS PKWY STE A
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5646
Practice Address - Country:US
Practice Address - Phone:704-895-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401351207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH25893Medicare UPIN
NC2035156Medicare ID - Type Unspecified