Basic Information
| Provider Information | |||||||||
| NPI: | 1861888034 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANDSDORFER | ||||||||
| FirstName: | CAITLIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NORCROSS | ||||||||
| OtherFirstName: | CAITLIN | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7 JOAN DR | ||||||||
| Address2: | |||||||||
| City: | NEWTOWN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064702219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034514215 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 805 W CEDAR ST | ||||||||
| Address2: | |||||||||
| City: | STANDISH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486589526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898464521 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2015 | ||||||||
| LastUpdateDate: | 01/08/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5101025147 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.