Provider Demographics
NPI:1164990529
Name:BRIAN C. DE MUTH, M.D., PA
Entity Type:Organization
Organization Name:BRIAN C. DE MUTH, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DE MUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-939-3400
Mailing Address - Street 1:210 CHESAPEAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6395
Mailing Address - Country:US
Mailing Address - Phone:410-398-3868
Mailing Address - Fax:410-620-3686
Practice Address - Street 1:251 LEWIS LN STE 103
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3752
Practice Address - Country:US
Practice Address - Phone:410-939-3400
Practice Address - Fax:410-939-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies