{
"Npi": {
"NPI": "1306099833",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CORYSE BRATHWAITE-DEAN, MD, PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 6438",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WALDORF",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20603-6438",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "301-705-6500",
"MailingAddressFaxNumber": "301-705-5822",
"FirstLinePracticeLocationAddress": "3460 OLD WASHINGTON RD",
"SecondLinePracticeLocationAddress": "SUITE 101",
"PracticeLocationAddressCityName": "WALDORF",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20602-3240",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-705-6500",
"PracticeLocationAddressFaxNumber": "301-705-5822",
"EnumerationDate": "10/28/2008",
"LastUpdateDate": "10/28/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRATHWAITE",
"AuthorizedOfficialFirstName": "CORYSE",
"AuthorizedOfficialMiddleName": "V",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "301-705-6500",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "D46239",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}