Healthcare Provider Details

I. General information

NPI: 1740395029
Provider Name (Legal Business Name): DAMIAN BREZINSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 LAKE PARK BLVD N STE 103
CAROLINA BEACH NC
28428-3906
US

IV. Provider business mailing address

1328 LAKE PARK BLVD N STE 103
CAROLINA BEACH NC
28428-3906
US

V. Phone/Fax

Practice location:
  • Phone: 910-341-3301
  • Fax: 910-341-7946
Mailing address:
  • Phone: 910-341-3300
  • Fax: 910-341-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35595
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: