Paul Dennis Brant, O.D.
Individual provider Active NPI Optometrist · Cambridge, MD
NPI 1962490714 · NPPES record last updated Oct 14, 2008
Key facts
- NPI
- 1962490714
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- TAO742 (MD)
- Practice address
- 401 Race St
Cambridge, MD 21613-1835 - Phone
- (410) 228-0500
- Fax
- (410) 228-0504
- NPI assigned
- Oct 6, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TAO742 | MD | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TAO742 | MD | Yes |
Addresses
Primary practice location
401 Race St
Cambridge, MD 21613-1835
Mailing address
401 Race St
P.O. Box 976
Cambridge, MD 21613-1835
Phone (410) 228-0500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6902000000Z671 | Other | MD | CARE FIRST |
| 4379297 | Other | MD | AETNA |
| 771378900 | Medicaid | MD | |
| 21434 | Other | MD | MDIPA/MAMSI |
Other providers in Cambridge, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.