Provider Demographics
NPI:1700885068
Name:BRULL, STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:
Last Name:BRULL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VILLAGE SQ
Mailing Address - Street 2:STE 190
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1605
Mailing Address - Country:US
Mailing Address - Phone:410-821-6400
Mailing Address - Fax:410-296-4722
Practice Address - Street 1:1 VILLAGE SQ
Practice Address - Street 2:SUITE #190
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1602
Practice Address - Country:US
Practice Address - Phone:410-435-8881
Practice Address - Fax:410-435-8886
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0002515207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC57413Medicare UPIN
MDK892GG78Medicare ID - Type Unspecified