Provider Demographics
NPI:1548235336
Name:SHARKEY, BRIAN (CRNP)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:SHARKEY
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MAIDEN CHOICE LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5968
Mailing Address - Country:US
Mailing Address - Phone:410-737-8838
Mailing Address - Fax:410-314-7979
Practice Address - Street 1:711 MAIDEN CHOICE LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-3632
Practice Address - Country:US
Practice Address - Phone:410-247-5602
Practice Address - Fax:410-247-1756
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR137750363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401198800Medicaid
8301302OtherEVERCARE
0943ER-618712-03OtherCAREFIRST BCBS OF MD
MD61871201OtherBCBS
138CER618172-01OtherCAREFIRST BCBS OF MD
MD960702100Medicaid
T016-0033OtherBCBS-DC
MDF675Medicare PIN
MDP00029692Medicare PIN
138CER618172-01OtherCAREFIRST BCBS OF MD