1619293313 NPI number — BRANDON FORD LEBOW M.D.

Table of content: BRANDON FORD LEBOW M.D. (NPI 1619293313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619293313 NPI number — BRANDON FORD LEBOW M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEBOW
Provider First Name:
BRANDON
Provider Middle Name:
FORD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619293313
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 ELMWOOD AVE
Provider Second Line Business Mailing Address:
BOX 604
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14642-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-275-1385
Provider Business Mailing Address Fax Number:
585-244-7271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 E UNIVERSITY PKWY
Provider Second Line Business Practice Location Address:
DEPT OF MEDICINE
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-2829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-554-6755
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  279379 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)