Provider Demographics
NPI:1679501316
Name:BIRELY, BRENT C (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:C
Last Name:BIRELY
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 1:1300 YORK RD
Mailing Address - Street 2:BUILDING A, SUITE 100
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6016
Mailing Address - Country:US
Mailing Address - Phone:410-828-9570
Mailing Address - Fax:410-583-9120
Practice Address - Street 1:1300 YORK RD
Practice Address - Street 2:BUILDING A, SUITE 100
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6016
Practice Address - Country:US
Practice Address - Phone:410-828-9570
Practice Address - Fax:410-583-9120
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00360282086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCE681 0001OtherCAREFIRST
GADA3208 240007648OtherRAILROAD MEDICARE
GADA3208 240007648OtherRAILROAD MEDICARE
MD310M419FMedicare PIN