MEDICARE: BRANDEE THOMAS PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA101970	MA
2	363A00000X	Physician Assistant	0110010119	VA
3	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0110010119	OTHER	VA	PA LICENSE NUMBER

General Provider Information

NPI Number	:	1265272983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDEE THOMAS PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	280 CHESTNUT ST FL 2
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01199-1001
Country	:	US
Telephone Number	:	413-794-5700
Fax Number	:	413-794-1629

Provider Business Practice Location Address
First Line	:	325B KING ST # 3
Second Line	:
City	:	NORTHAMPTON
State	:	MA
Zip	:	01060-2370
Country	:	US
Telephone Number	:	413-387-4101
Fax Number	:	413-387-4119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2024
Last Update Date	:	12/01/2025

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