Provider Demographics
NPI:1962455667
Name:BRUNO HOLTAN, BRIANA DANILLE (MS)
Entity Type:Individual
Prefix:MS
First Name:BRIANA
Middle Name:DANILLE
Last Name:BRUNO HOLTAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:BRIANA
Other - Middle Name:DANILLE
Other - Last Name:BRUNO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:9613 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2150
Mailing Address - Country:US
Mailing Address - Phone:410-668-5500
Mailing Address - Fax:410-668-5650
Practice Address - Street 1:9613 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-2150
Practice Address - Country:US
Practice Address - Phone:410-668-5500
Practice Address - Fax:410-668-5650
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00909231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD150LD604Medicare ID - Type Unspecified