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NPI Code Detail

MEDICARE: MARK BREJT MD

MEDICARE:   MARK  BREJT  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician35061693OH
22085B0100XBody Imaging Physician35061693OH
32085D0003XDiagnostic Neuroimaging (Radiology) Physician35061693OH
42085U0001XDiagnostic Ultrasound Physician35061693OH
52085H0002XHospice and Palliative Medicine (Radiology) Physician35061693OH
62085N0700XNeuroradiology Physician35061693OH
72085N0904XNuclear Radiology Physician35061693OH
82085P0229XPediatric Radiology Physician35061693OH
92085R0001XRadiation Oncology Physician35061693OH
102085R0203XTherapeutic Radiology Physician35061693OH
112085R0204XVascular & Interventional Radiology Physician35061693OH
12207U00000XNuclear Medicine Physician35061693OH
13207UN0903XIn Vivo & In Vitro Nuclear Medicine Physician35061693OH
14207UN0901XNuclear Cardiology Physician35061693OH
15207UN0902XNuclear Imaging & Therapy Physician35061693OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00412293OTHEROHRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000503601OTHEROHANTHEM
20304914OTHEROHBCMH
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6363378OTHEROHWELLCARE
7000000221357OTHEROHUNISON
84334561OTHEROHAETNA
9745377OTHEROHBUCKEYE

General Provider Information

NPI Number : 1255378196
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK BREJT MD
Provider Business Mailing Address
First Line : 3621 SEVERN RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44118-1906
Country : US
Telephone Number : 216-926-6899
Fax Number : 216-371-3465
Provider Business Practice Location Address
First Line : 3621 SEVERN RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44118-1906
Country : US
Telephone Number : 216-321-1203
Fax Number : 216-371-3465
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2006
Last Update Date : 04/04/2012

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