Provider Demographics
NPI:1063470235
Name:BRIGLIA, ANDREW E (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:E
Last Name:BRIGLIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 64152
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4152
Mailing Address - Country:US
Mailing Address - Phone:443-481-6483
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:104 FORBES ST STE 102
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1543
Practice Address - Country:US
Practice Address - Phone:410-571-8333
Practice Address - Fax:410-573-8338
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDH53429207RN0300X
MDH0053429207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD322801100Medicaid
MD135322Medicare PIN