Healthcare Provider Details

I. General information

NPI: 1255570842
Provider Name (Legal Business Name): BRAD PFEFFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6190 GEORGETOWN BLVD STE 109
ELDERSBURG MD
21784-6460
US

IV. Provider business mailing address

5051 GREENSPRING AVE STE 304
BALTIMORE MD
21209-4358
US

V. Phone/Fax

Practice location:
  • Phone: 410-552-4233
  • Fax:
Mailing address:
  • Phone: 410-601-7790
  • Fax: 410-601-8704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD73112
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: