Healthcare Provider Details

I. General information

NPI: 1477996155
Provider Name (Legal Business Name): BRANDON W BARRETT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 12/17/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOUNT AUBURN ST SOUTH 2-DEPARTMENT OF SURGERY
CAMBRIDGE MA
02138-5502
US

IV. Provider business mailing address

1580 SKEET CLUB RD
HIGH POINT NC
27265-9530
US

V. Phone/Fax

Practice location:
  • Phone: 617-497-2420
  • Fax: 617-499-5593
Mailing address:
  • Phone: 336-883-0029
  • Fax: 336-899-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1305
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number660
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: