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General NPI Number Information
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NPI Number | 1417386095
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Entity Type | Individual
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Provider Name | BRIAN L SIMERVILLE MA, ATC
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Gender | Male
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 11/05/2013
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Provider Practice Location Address
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Address Line | GOSSETT FOOTBALL TEAM HOUSE UNIVERSITY OF MARYLAND
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City | COLLEGE PARK
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State | MD
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Zip | 20742-0001
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Country | US
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Telephone | 301-314-9901
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Fax | 877-863-2802
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Provider Business Mailing Address
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Address Line | 486 FAWNS WALK
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City | ANNAPOLIS
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State | MD
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Zip | 21409-5657
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Country | US
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Telephone | 410-212-8506
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | A0000150
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License Number State | MD
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