Healthcare Provider Details

I. General information

NPI: 1972743912
Provider Name (Legal Business Name): BRIAN C. DE MUTH, M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W BALTIMORE PIKE STE 101
WEST GROVE PA
19390-9313
US

IV. Provider business mailing address

210 CHESAPEAKE BLVD
ELKTON MD
21921-6395
US

V. Phone/Fax

Practice location:
  • Phone: 610-869-0234
  • Fax: 610-869-6544
Mailing address:
  • Phone: 410-398-3868
  • Fax: 410-620-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD431985
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN CHARLES DE MUTH
Title or Position: OWNER
Credential: M.D.
Phone: 610-869-0234