1598733776 NPI number — DR. BRIAN R SUBACH M.D.

Table of content: DR. BRIAN R SUBACH M.D. (NPI 1598733776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598733776 NPI number — DR. BRIAN R SUBACH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUBACH
Provider First Name:
BRIAN
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598733776
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11350 MCCORMICK RD
Provider Second Line Business Mailing Address:
EXECUTIVE PLAZA 1, STE. 501
Provider Business Mailing Address City Name:
HUNT VALLEY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-914-8000
Provider Business Mailing Address Fax Number:
703-709-6516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6710 OXON HILL RD STE 550
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXON HILL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20745-1117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-485-7400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  0101233865 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)