MEDICARE: DR. BRIAN E MONDELL M.D.

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
1	2084N0400X	Neurology Physician	D0032496	MD
2	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	D0032496	MD

General Provider Information

NPI Number	:	1407869217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN E MONDELL M.D.

Provider Business Mailing Address
First Line	:	724 LIGHT ST STE A
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-3813
Country	:	US
Telephone Number	:	443-869-5641
Fax Number	:	443-869-5642

Provider Business Practice Location Address
First Line	:	724 LIGHT ST STE A
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-3813
Country	:	US
Telephone Number	:	443-869-5461
Fax Number	:	443-869-5642

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	09/11/2024

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