Basic Information
| Provider Information | |||||||||
| NPI: | 1891786802 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANDOFF | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | EVAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44 BINNEY ST | ||||||||
| Address2: | DANA-FARBER CANCER INSTITUTE | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021156013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176326464 | ||||||||
| FaxNumber: | 6176326180 | ||||||||
| Practice Location | |||||||||
| Address1: | 44 BINNEY ST | ||||||||
| Address2: | DANA-FARBER CANCER INSTITUTE | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021156013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176326464 | ||||||||
| FaxNumber: | 6176326180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 08/13/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0002X | 223968 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 468146 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 2101084 | 05 | MA | MEDICAID | J28577 | 01 | MA | BCBS OF MA | OTHER |