NPI Code Detail JSON Logo

1861577553 NPI number — BERGINA BRICKHOUSE ISBELL MD

NPI Number: 1861577553
Health Care Provider/Practitioner: BERGINA BRICKHOUSE ISBELL MD

Information about “1861577553” NPI (BERGINA BRICKHOUSE ISBELL MD) exists in 1861577553 in HTML format HTML  |  1861577553 in plain Text format TXT  |  1861577553 in PDF (Portable Document Format) PDF  |  1861577553 in an XML format XML  formats.

NPI Number : 1861577553 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1861577553",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ISBELL",
    "FirstName": "BERGINA",
    "MiddleName": "BRICKHOUSE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BRICKHOUSE",
    "OtherFirstName": "BERGINIA",
    "OtherMiddleName": "LAMONDA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "PO BOX 6500",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLUMBIA",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21045-6500",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "507-533-5441",
    "MailingAddressFaxNumber": "844-511-6928",
    "FirstLinePracticeLocationAddress": "3355 SAINT JOHNS LN STE F",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ELLICOTT CITY",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21042-2600",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "507-533-5433",
    "PracticeLocationAddressFaxNumber": "844-511-6928",
    "EnumerationDate": "10/25/2006",
    "LastUpdateDate": "12/23/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "4301113664",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "49112",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "MD039796",
          "LicenseNumberStateCode": "DC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "MD437961",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "C150811",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "D83609",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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