Provider Demographics
NPI:1326004433
Name:BLOCK, BRIAN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MICHAEL
Last Name:BLOCK
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 1:8322 BELLONA AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2065
Mailing Address - Country:US
Mailing Address - Phone:410-825-8970
Mailing Address - Fax:
Practice Address - Street 1:8322 BELLONA AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-2065
Practice Address - Country:US
Practice Address - Phone:410-825-8970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD58724207L00000X, 207LC0200X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402087100Medicaid
MDKR79G225Medicare ID - Type Unspecified
MDH85685Medicare UPIN
MDKR78H712Medicare ID - Type Unspecified
MD402087100Medicaid