Healthcare Provider Details

I. General information

NPI: 1326004433
Provider Name (Legal Business Name): BRIAN MICHAEL BLOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8322 BELLONA AVE SUITE 330
BALTIMORE MD
21204-2065
US

IV. Provider business mailing address

8322 BELLONA AVE SUITE 330
BALTIMORE MD
21204-2065
US

V. Phone/Fax

Practice location:
  • Phone: 410-825-8970
  • Fax:
Mailing address:
  • Phone: 410-825-8970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD58724
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberD58724
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberD58724
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: