Healthcare Provider Details

I. General information

NPI: 1598855124
Provider Name (Legal Business Name): BRIAN J BOHNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 FAIRMOUNT AVE STE 500
TOWSON MD
21286-5466
US

IV. Provider business mailing address

501 FAIRMOUNT AVE STE 103
TOWSON MD
21286-5457
US

V. Phone/Fax

Practice location:
  • Phone: 410-494-1662
  • Fax: 410-494-1718
Mailing address:
  • Phone: 410-494-7921
  • Fax: 410-902-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD0043489
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberD0043489
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD0043489
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0010 E554
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerBLUE CHOICE/FEP
# 2
Identifier1037339
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITED HEALTHCARE
# 3
Identifier52688201 420A
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerBLUE SHIELD
# 4
Identifier242476
Identifier TypeOTHER
Identifier State
Identifier IssuerMAMSI
# 5
Identifier290008366
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE
# 6
Identifier4800130
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITEDHEALTHCARE MCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: