Provider Demographics
NPI:1184648198
Name:BRINKLEY, SUSAN BARNETT (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:BARNETT
Last Name:BRINKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4398
Mailing Address - Country:US
Mailing Address - Phone:301-668-2800
Mailing Address - Fax:301-668-0611
Practice Address - Street 1:198 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4398
Practice Address - Country:US
Practice Address - Phone:301-668-2800
Practice Address - Fax:301-668-0611
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043389207R00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21D0993259OtherCLIA LAB #
MDD0043389OtherLICENCE
MDD0043389OtherLICENCE