MEDICARE: BRANDI J RAPPAPORT 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	207Q00000X	Family Medicine Physician	25MA07886600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609835248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI J RAPPAPORT MD

Provider Business Mailing Address
First Line	:	500 GROVE ST
Second Line	:	SUITE 100
City	:	HADDON HEIGHTS
State	:	NJ
Zip	:	08035-1702
Country	:	US
Telephone Number	:	856-796-9200
Fax Number	:	856-310-5603

Provider Business Practice Location Address
First Line	:	45 HOMESTEAD DR
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	NJ
Zip	:	08022-1004
Country	:	US
Telephone Number	:	609-324-0993
Fax Number	:	609-324-0995

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	07/08/2007

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