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1053305052

NPI Code Detail

MEDICARE: DAVID S BRANTLEY MD

MEDICARE: DAVID S BRANTLEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	32645	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	370008638	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6262907	OTHER	NC	AENTA
2	8462532	OTHER	NC	CIGNA HEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	73705	OTHER	NC	MEDCOST
6	1068G	OTHER	NC	BCBSNC
7	1735023	OTHER	NC	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1053305052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID S BRANTLEY MD

Provider Business Mailing Address
First Line	:	PO BOX 7200
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-0200
Country	:	US
Telephone Number	:	252-937-0200
Fax Number	:	252-451-0056

Provider Business Practice Location Address
First Line	:	91 ENTERPRISE DR
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-9590
Country	:	US
Telephone Number	:	252-451-3100
Fax Number	:	252-937-3106

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	03/06/2019

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1801896618 — GRACE MAYAMIKO JERE MD
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1588658504 — DONALD W BALES MD
Practice Location Address:

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1659365690 — MARTHA J CHESNUTT MD
Practice Location Address:

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1205820214 — VASANTH B BALIGA MD
Practice Location Address:

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1194719104 — DAVID ALLEN BROWDER MD
Practice Location Address:

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Directions to “ DAVID S BRANTLEY MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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