Provider Demographics
NPI:1619083706
Name:BRYNELSON, BARBARA JEANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:JEANNE
Last Name:BRYNELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 DAIRYFIELD CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4227
Mailing Address - Country:US
Mailing Address - Phone:301-770-9253
Mailing Address - Fax:301-984-6225
Practice Address - Street 1:6000 EXECUTIVE BLVD
Practice Address - Street 2:SUITE115
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3803
Practice Address - Country:US
Practice Address - Phone:301-984-8112
Practice Address - Fax:301-984-6225
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037768208000000X
DC17413208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC83023Medicare UPIN