1184681934 NPI number — DR. MERRY A BRANTLEY AUD

Table of content: DR. MERRY A BRANTLEY AUD (NPI 1184681934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184681934 NPI number — DR. MERRY A BRANTLEY AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANTLEY
Provider First Name:
MERRY
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

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:
1184681934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE AYRES CIRCLE, BUILDING H-1, PORTSMOUTH NAVAL SHIPYD
Provider Second Line Business Mailing Address:
NAVAL HEALTH CARE NEW ENGLAND, BRANCH CLINIC
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03804-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-438-2081
Provider Business Mailing Address Fax Number:
207-438-1754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE AYRES CIRCLE, BUILDING H-1, PORTSMOUTH NAVAL SHIPYD
Provider Second Line Business Practice Location Address:
NAVAL HEALTH CARE NEW ENGLAND, BRANCH CLINIC
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03804-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-438-2081
Provider Business Practice Location Address Fax Number:
207-438-1754
Provider Enumeration Date:
04/26/2006

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: 231H00000X , with the licence number:  A404 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020473740 . This is a "HUMANA CHOICE CARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 020473740 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 020473740 . This is a "GREAT WEST HEALTHCARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2924917 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30432258 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 73Y002891NH01 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 020473740 . This is a "TRICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 640004535 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: AA14036 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 020473740 . This is a "HEALTHCARE VALUE MGMT" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 020473740 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2512656 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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