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General NPI Number Information
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NPI Number | 1215517982
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Entity Type | Organization
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Legal Business Name | BRILLIANTMINDS PSYCHIATRY, LLC
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Dates
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Enumeration Date | 04/08/2021
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 301 HOSPITAL DR
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City | GLEN BURNIE
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State | MD
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Zip | 21061-5803
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Country | US
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Telephone | 410-908-4175
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Fax | 410-709-6685
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Provider Business Mailing Address
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Address Line | 9091 SNOWDEN RIVER PKWY # 1215
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City | COLUMBIA
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State | MD
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Zip | 21046-1657
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Country | US
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Telephone | 410-908-4175
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Fax | 410-709-6685
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Authorized Official
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Title or Position | MEMBER
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Name | BISHOY MICHAEL
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Credential | MD
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Telephone | 410-908-4175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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