Provider Demographics
NPI:1659532513
Name:DESAULNIERS, BRIAN M (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:DESAULNIERS
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 1:100 E CARROLL ST
Mailing Address - Street 2:EMERGENCY SERVICE ASSOCIATES
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5422
Mailing Address - Country:US
Mailing Address - Phone:410-543-7742
Mailing Address - Fax:410-546-6350
Practice Address - Street 1:100 E CARROLL ST
Practice Address - Street 2:EMERGENCY SERVICE ASSOCIATES
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5422
Practice Address - Country:US
Practice Address - Phone:410-543-7742
Practice Address - Fax:410-546-6350
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL31043207P00000X
MDD0072095207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine