Healthcare Provider Details

I. General information

NPI: 1770562548
Provider Name (Legal Business Name): WILLIAM ROBERT BRANDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MANET COMMUNITY HEALTH CENTER 1 WASHINGTON ST.
TAUNTON MA
02780
US

IV. Provider business mailing address

110 WEST SQUANTUM ST. BUSINESS OFFICE
NORTH QUINCY MA
02171
US

V. Phone/Fax

Practice location:
  • Phone: 617-376-3000
  • Fax: 617-774-1905
Mailing address:
  • Phone: 617-376-3000
  • Fax: 617-774-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14830
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: