Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Brandon Fairless, MD

Individual provider Pediatric Nephrology Physician · NPI 1659802502

Dr. Brandon Fairless, MD is a Pediatric Medicine in Philadelphia, Pennsylvania. Qualified in 2017, 9 years ago. Licensed in Louisiana and Pennsylvania.

Years since qualifying
9
Licensed in
LA, PA
In the registry since
2017
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Phone: (215) 590-2449
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Nephrology Physician (primary) Taxonomy 2080P0210X · Licence MD486184 (PA)
Pediatrics Physician Taxonomy 208000000X · Licence 322248 (LA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1659802502
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 22, 2017
Last updated in NPPESOctober 15, 2025
Certification dateOctober 15, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPEDIATRIC MEDICINE
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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