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General NPI Number Information
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NPI Number | 1427363795
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Entity Type | Organization
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Legal Business Name | BRIAN E MONDELL, MD LLC
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 10/01/2010
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Provider Practice Location Address
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Address Line | 14 S BROADWAY
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City | BALTIMORE
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State | MD
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Zip | 21231-1712
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Country | US
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Telephone | 410-276-1773
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Fax | 410-276-2056
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Provider Business Mailing Address
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Address Line | 2331 OLD COURT RD SUITE 405
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City | BALTIMORE
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State | MD
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Zip | 21208-3422
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Country | US
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Telephone | 410-321-4558
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Fax | 410-494-1047
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. BRIAN E MONDELL
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Credential | MD
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Telephone | 410-321-4558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | D0032496
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License Number State | MD
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