Healthcare Provider Details

I. General information

NPI: 1013948488
Provider Name (Legal Business Name): JOHN PHILIP BYRNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8926 WOODYARD ROAD SUITE 701
CLINTON MD
20735
US

IV. Provider business mailing address

8926 WOODYARD ROAD SUITE 701
CLINTON MD
20735
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-1682
  • Fax: 301-856-0964
Mailing address:
  • Phone: 301-856-1682
  • Fax: 301-856-0964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0040832
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101045693
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD19079
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: