Healthcare Provider Details

I. General information

NPI: 1699064196
Provider Name (Legal Business Name): BRANDON PHILIP OLIVIERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 LOTAWATAH DR
BURNSVILLE NC
28714-5038
US

IV. Provider business mailing address

1010 N 102ND ST STE 201
OMAHA NE
68114-2122
US

V. Phone/Fax

Practice location:
  • Phone: 833-228-6889
  • Fax:
Mailing address:
  • Phone: 833-228-6889
  • Fax: 877-853-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMC-255
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD-53573
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME131503
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number202302765
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: