Individual provider Active NPI

Mary Weber Brandon, D.O.

  • Anesthesiology Physician
  • Durham, NC
National Provider Identifier
1720240823
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
0102203181 Issued in VA
Practice address
2100 Erwin Rd
Durham, NC 27705-3941
Phone
(919) 684-8111
NPI assigned
Jun 30, 2008
Last updated
Jul 1, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 150467 NC
Anesthesiology Physician 207L00000X 0102203181 VA Primary
Anesthesiology Physician 207L00000X 2009-00944 NC

Addresses

Primary practice location

2100 Erwin Rd
Durham, NC 27705-3941

Mailing address

5213 S Alston Ave
Durham, NC 27713-4430
Phone (919) 620-4700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121221000061 VA Practitioner - Anesthesiology 9537323050 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
West Virginia School of Osteopathic Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

13710 St Francis Blvd
Midlothian, VA 23114-3267
Phone (516) 370-3858

19455 Deerfield Ave
Suite 204
Leesburg, VA 20176-8102
Phone (703) 724-9950

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
0102203181VAMDAnesthesiology Physician
150467NCMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
American Anesthesiology of Virginia, PC Anesthesiology CurrentSince Jan 19, 2016 Accepting new patients
American Anesthesiology of Virginia PC Anesthesiology CurrentSince Jan 19, 2016 Accepting new patients
Hanover Anesthesia Group,Inc Anesthesiology Past Accepting new patients

Locations

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

19455 Deerfield Ave
Ste 204
Leesburg, VA 20176
Phone (703) 724-9950

8260 Atlee Rd
Mechanicsvlle, VA 23116
Phone (804) 264-6000

2369 Staples Mill Rd
Ste 100
Richmond, VA 23230
Phone (804) 354-8818

5801 Bremo Rd
Richmond, VA 23226
Phone (804) 281-8220

5855 Bremo Rd
Ste 100
Richmond, VA 23226
Phone (804) 288-6258

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1720240823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5213 S ALSTON AVE",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277134430",
            "telephone_number": "919-620-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277053941",
            "telephone_number": "919-684-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDON",
        "first_name": "MARY",
        "middle_name": "WEBER",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-30",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NC",
            "license": "150467",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VA",
            "license": "0102203181",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NC",
            "license": "2009-00944",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.