Provider Demographics
NPI:1790373330
Name:STINE, BRIANA NICOLE
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:NICOLE
Last Name:STINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 RANGING HILLS GATE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6068
Mailing Address - Country:US
Mailing Address - Phone:443-812-2757
Mailing Address - Fax:
Practice Address - Street 1:6504 RANGING HILLS GATE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-6068
Practice Address - Country:US
Practice Address - Phone:443-812-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0007786208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology