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NPI Code Detail

MEDICARE: RUSSELL V BRANT MD

MEDICARE: RUSSELL V BRANT MD
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
1207R00000XInternal Medicine Physician9199SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508859927
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUSSELL V BRANT MD
Provider Business Mailing Address
First Line : 1278 N LAFAYETTE DR
Second Line :
City : SUMTER
State : SC
Zip : 29150-2964
Country : US
Telephone Number : 803-774-4500
Fax Number : 803-744-4627
Provider Business Practice Location Address
First Line : 1278 N LAFAYETTE DR
Second Line :
City : SUMTER
State : SC
Zip : 29150-2964
Country : US
Telephone Number : 803-774-4500
Fax Number : 803-974-4627
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2005
Last Update Date : 03/04/2010

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Directions to “ RUSSELL V BRANT MD” Practice Location

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