Provider Demographics
NPI:1407869217
Name:MONDELL, BRIAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:E
Last Name:MONDELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2331 OLD COURT RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3422
Mailing Address - Country:US
Mailing Address - Phone:410-321-4558
Mailing Address - Fax:410-494-1047
Practice Address - Street 1:1501 DIVISION ST
Practice Address - Street 2:TOTAL HEALTH CARE, DIVISION OF SUBSTANCE ABUSE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-3121
Practice Address - Country:US
Practice Address - Phone:410-735-5369
Practice Address - Fax:410-728-4732
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD00324962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE00537Medicare UPIN