Individual
DR. BRANDON FAIRLESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(215) 590-2449
Mailing address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(215) 590-2449
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
322248
LA
2080P0210X
Pediatric Nephrology Physician
Primary
MD486184
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2017
Last updated
10/15/2025
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