Healthcare Provider Details

I. General information

NPI: 1265446454
Provider Name (Legal Business Name): THOMAS A. BRANDES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MATTHEW ST EMERGENCY DEPT
MARIETTA OH
45750-1635
US

IV. Provider business mailing address

9075 NEW ENGLAND RD
STEWART OH
45778-9541
US

V. Phone/Fax

Practice location:
  • Phone: 740-376-1939
  • Fax: 740-374-1693
Mailing address:
  • Phone: 740-541-0985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.006958
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: