Provider Demographics
NPI:1255438776
Name:DOCTORS BRANTON & JARRAH, PA
Entity type:Organization
Organization Name:DOCTORS BRANTON & JARRAH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:JARRAH
Authorized Official - Last Name:BRANTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-546-5141
Mailing Address - Street 1:1205 PEMBERTON DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801
Mailing Address - Country:US
Mailing Address - Phone:410-546-5141
Mailing Address - Fax:410-548-7574
Practice Address - Street 1:1205 PEMBERTON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-546-5141
Practice Address - Fax:410-548-7574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0050743207R00000X
MDD0050614207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS327OtherBLUE CHOICE
MDLR35OtherCARE FIRST
MD690941800Medicaid
MDS327OtherBLUE CHOICE
G28192Medicare UPIN
G28285Medicare UPIN