Provider Demographics
NPI:1790313781
Name:PHILBRICK, BRIANNA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MARIE
Last Name:PHILBRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 TATE ST UNIT 2B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-4081
Mailing Address - Country:US
Mailing Address - Phone:207-745-9096
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMHALL ST # 2B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3175
Practice Address - Country:US
Practice Address - Phone:207-662-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program