Provider Demographics
NPI:1487220539
Name:BRANDLE, MICHAEL ALLEN JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:BRANDLE
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:725 ALBANY ST STE 7C
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3549
Mailing Address - Country:US
Mailing Address - Phone:617-638-8992
Mailing Address - Fax:
Practice Address - Street 1:725 ALBANY STREET SUITE 7C
Practice Address - Street 2:SHAPIRO BUILDING
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-8992
Practice Address - Fax:617-638-8979
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2024-11-23
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Provider Licenses
StateLicense IDTaxonomies
MAPA8810363A00000X, 363A00000X
CT5533363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant