Provider Demographics
NPI:1700221603
Name:BRANDT, DANIEL RYAN (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RYAN
Last Name:BRANDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:1945 MARLTON PIKE E STE D
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003
Practice Address - Country:US
Practice Address - Phone:856-237-8045
Practice Address - Fax:856-237-8047
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2024-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA10132100207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0747483Medicaid