MEDICARE: DR. ASHLEY JEAN FAIRBROTHER BRANDON M.D.

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	208800000X	Urology Physician	201500570	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	562140200	OTHER	NC	FEDERAL TAX ID

General Provider Information

NPI Number	:	1790912574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLEY JEAN FAIRBROTHER BRANDON M.D.

Provider Business Mailing Address
First Line	:	1236 HUFFMAN MILL RD STE 1300
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-8700
Country	:	US
Telephone Number	:	336-227-2761
Fax Number	:	336-585-0688

Provider Business Practice Location Address
First Line	:	1236 HUFFMAN MILL RD STE 1300
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-8700
Country	:	US
Telephone Number	:	336-227-2761
Fax Number	:	336-585-0688

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

Provider Enumeration Date	:	06/18/2009
Last Update Date	:	12/05/2025

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Directions to “ DR. ASHLEY JEAN FAIRBROTHER BRANDON M.D.” Practice Location

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