Provider Demographics
NPI:1497761977
Name:CORWELL, BRIAN NIALL (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:NIALL
Last Name:CORWELL
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:PO BOX 64134
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4134
Mailing Address - Country:US
Mailing Address - Phone:667-214-2714
Mailing Address - Fax:419-448-6926
Practice Address - Street 1:7140 CONTEE RD STE 3000
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-9532
Practice Address - Country:US
Practice Address - Phone:410-448-6400
Practice Address - Fax:240-636-9790
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0663194207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410686500Medicaid
MDP00349929OtherRAILROAD
MD451601000Medicaid
MD613LO370Medicare PIN
MD613LMedicare ID - Type UnspecifiedMEDICARE GRP #
MDP00349929OtherRAILROAD
MD410686500Medicaid