Healthcare Provider Details

I. General information

NPI: 1699718379
Provider Name (Legal Business Name): LARRY K BIRRIEL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 PORTER ST FORT DETRICK ARMY GARRISON
FREDERICK MD
21702-9211
US

IV. Provider business mailing address

1433 PORTER ST FORT DETRICK ARMY GARRISON
FREDERICK MD
21702-9211
US

V. Phone/Fax

Practice location:
  • Phone: 301-624-1200
  • Fax: 240-379-7013
Mailing address:
  • Phone: 301-624-1200
  • Fax: 240-379-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC003204L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: