Provider Demographics
NPI:1033109822
Name:BREZA, GEORGE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:BREZA
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 1:13203 GRAMLICH RD SW
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6121
Mailing Address - Country:US
Mailing Address - Phone:301-759-1253
Mailing Address - Fax:
Practice Address - Street 1:13203 GRAMLICH RD SW
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-6121
Practice Address - Country:US
Practice Address - Phone:301-759-1253
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0012532174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD76157Medicare UPIN