MEDICARE: DR. DENIS F BRANSON 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	208200000X	Plastic Surgery Physician	162343	NY
2	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	162343	NY
3	2086S0122X	Plastic and Reconstructive Surgery Physician	162343	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	070001967	OTHER	NY	PALMETTO GBA MEDICARE PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	161288118	OTHER	NY	TAX ID

General Provider Information

NPI Number	:	1902848047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENIS F BRANSON MD

Provider Business Mailing Address
First Line	:	7000 E GENESEE ST
Second Line	:	BUILDING E
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-1131
Country	:	US
Telephone Number	:	315-446-8313
Fax Number	:	315-446-5387

Provider Business Practice Location Address
First Line	:	7000 E GENESEE ST
Second Line	:	BUILDING E
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-1131
Country	:	US
Telephone Number	:	315-446-8313
Fax Number	:	315-446-5387

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	01/06/2011

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Directions to “ DR. DENIS F BRANSON MD” Practice Location

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