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General NPI Number Information
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NPI Number | 1700885068
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Entity Type | Individual
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Provider Name | STANLEY BRULL M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 04/27/2016
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Provider Practice Location Address
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Address Line | 1 VILLAGE SQ SUITE #190
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City | BALTIMORE
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State | MD
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Zip | 21210-1602
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Country | US
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Telephone | 410-435-8881
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Fax | 410-435-8886
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Provider Business Mailing Address
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Address Line | 1 VILLAGE SQ STE 190
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City | BALTIMORE
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State | MD
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Zip | 21210-1605
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Country | US
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Telephone | 410-821-6400
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Fax | 410-296-4722
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | D0002515
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License Number State | MD
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