Basic Information
| Provider Information | |||||||||
| NPI: | 1588645782 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KAREN GAIL BRANDSE MD & ASSOC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 TOTTEN POND RD | ||||||||
| Address2: | C O MZI | ||||||||
| City: | WALTHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024511906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818909933 | ||||||||
| FaxNumber: | 7818909950 | ||||||||
| Practice Location | |||||||||
| Address1: | 67 UNION ST | ||||||||
| Address2: | |||||||||
| City: | NATICK | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017607700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086507640 | ||||||||
| FaxNumber: | 5086507814 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BRANDSE | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | GAIL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5086507640 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 153726 | MA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 66912 | 01 | MA | HPHC | OTHER | 9713671 | 05 | MA | MEDICAID | M18407 | 01 | MA | BCBS | OTHER | 691581 | 01 | MA | TUFTS | OTHER |