Provider Demographics
NPI:1568468841
Name:BRILEY, PHILIP L (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:L
Last Name:BRILEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 OLD BRANCH AVE
Mailing Address - Street 2:STE B105
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1628
Mailing Address - Country:US
Mailing Address - Phone:301-934-8811
Mailing Address - Fax:301-934-9321
Practice Address - Street 1:7700 OLD BRANCH AVE
Practice Address - Street 2:STE B105
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1628
Practice Address - Country:US
Practice Address - Phone:301-934-8811
Practice Address - Fax:301-934-9321
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2010-03-03
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
MD00628103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD281092OtherKAISER
DC38160001OtherBLUE CROSS
MD414910600Medicaid
MD513212OtherNCPPO
MD521255282OtherTRICARE
MDG074PLOtherBLUE CROSS
MD460568000OtherMAGELLAN
MD289607OtherMAMSI/ALLIANCE/MDIPA/OP
DC114209Medicare ID - Type UnspecifiedTRAILBLAZER
MD460568000OtherMAGELLAN