Provider Demographics
NPI:1134508963
Name:RIDDICK, BRITTNEY
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:RIDDICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4514 COLONEL GARDNER CRT
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772
Mailing Address - Country:US
Mailing Address - Phone:443-650-8516
Mailing Address - Fax:
Practice Address - Street 1:4514 COLONEL GARDNER CRT
Practice Address - Street 2:
Practice Address - City:CAMARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772
Practice Address - Country:US
Practice Address - Phone:443-650-8516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR01949225700000X
MD374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist