Healthcare Provider Details

I. General information

NPI: 1619083706
Provider Name (Legal Business Name): BARBARA JEANNE BRYNELSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 EXECUTIVE BLVD SUITE115
ROCKVILLE MD
20852-3803
US

IV. Provider business mailing address

17 DAIRYFIELD CT
ROCKVILLE MD
20852-4227
US

V. Phone/Fax

Practice location:
  • Phone: 301-984-8112
  • Fax: 301-984-6225
Mailing address:
  • Phone: 301-770-9253
  • Fax: 301-984-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0037768
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17413
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: