Healthcare Provider Details

I. General information

NPI: 1265446421
Provider Name (Legal Business Name): JOHN DENNIS BRANGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 N CHARLES ST SUITE 601
BALTIMORE MD
21204-6800
US

IV. Provider business mailing address

1501 AMESHIRE RD
LUTHERVILLE MD
21093-5919
US

V. Phone/Fax

Practice location:
  • Phone: 410-821-5151
  • Fax: 410-823-8309
Mailing address:
  • Phone: 410-825-2035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0018147
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: