Provider Demographics
NPI:1134450786
Name:WILLIAM F. BRUTHER, M.D., PC
Entity type:Organization
Organization Name:WILLIAM F. BRUTHER, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRUTHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-573-5177
Mailing Address - Street 1:2003 MEDICAL PKWY
Mailing Address - Street 2:SUITE G-90
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7992
Mailing Address - Country:US
Mailing Address - Phone:410-573-5177
Mailing Address - Fax:410-571-8624
Practice Address - Street 1:2003 MEDICAL PKWY
Practice Address - Street 2:SUITE G-90
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7992
Practice Address - Country:US
Practice Address - Phone:410-573-5177
Practice Address - Fax:410-571-8624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD121041600Medicaid
MDMD473QMedicare PIN
MD121041600Medicaid