Provider Demographics
NPI:1982635074
Name:BRENT C. BIRELY, M.D., P.A.
Entity Type:Organization
Organization Name:BRENT C. BIRELY, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:C
Authorized Official - Last Name:BIRELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-828-9570
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKBQ9BROtherCAREFIRST MD
GADA3208OtherRAILROAD MEDICARE
DCE681OtherCAREFIRST DC
DCE681OtherCAREFIRST DC