Provider Demographics
NPI:1871883231
Name:WHITED, BRANT (MD)
Entity type:Individual
Prefix:
First Name:BRANT
Middle Name:
Last Name:WHITED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 AVERY ST
Practice Address - Street 2:STE 501
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5192
Practice Address - Country:US
Practice Address - Phone:740-376-1994
Practice Address - Fax:740-376-1940
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.126416207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0126371Medicaid
WV3810029063Medicaid
OHH438550Medicare PIN