Healthcare Provider Details

I. General information

NPI: 1033109822
Provider Name (Legal Business Name): GEORGE MICHAEL BREZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13203 GRAMLICH RD SW
LAVALE MD
21502-6121
US

IV. Provider business mailing address

13203 GRAMLICH RD SW
LAVALE MD
21502-6121
US

V. Phone/Fax

Practice location:
  • Phone: 301-759-1253
  • Fax:
Mailing address:
  • Phone: 301-759-1253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0012532
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: