Provider Demographics
NPI:1861619058
Name:BRANDA, MARK T (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:BRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6451 N FEDERAL HWY STE 700
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1420
Mailing Address - Country:US
Mailing Address - Phone:855-808-2723
Mailing Address - Fax:
Practice Address - Street 1:77 BATES ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-784-5784
Practice Address - Fax:207-784-1477
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP00462207RG0100X
MEMD17628207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology