Provider Demographics
NPI:1891965349
Name:LERNER MD PA
Entity Type:Organization
Organization Name:LERNER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LERNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-284-2273
Mailing Address - Street 1:7434 HOLABIRD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-1829
Mailing Address - Country:US
Mailing Address - Phone:410-284-2273
Mailing Address - Fax:410-284-2816
Practice Address - Street 1:7434 HOLABIRD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-1829
Practice Address - Country:US
Practice Address - Phone:410-284-2273
Practice Address - Fax:410-284-2816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1982152W00000X
MDD0022694207W00000X
MDD26533207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD255261200OtherMEDICAL ASSISTANCE
GACB9671OtherRAILROAD MEDICARE
MDKX93LEOtherCAREFIRST
MD402LOtherMEDICARE
DCJ226OtherCAREFIRST