1073503918 NPI number — STEVEN HOWARD BRICK MD

Table of content: STEVEN HOWARD BRICK MD (NPI 1073503918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073503918 NPI number — STEVEN HOWARD BRICK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRICK
Provider First Name:
STEVEN
Provider Middle Name:
HOWARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1073503918
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4061 POWDER MILL RD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
CALVERTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20705-3149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-669-8501
Provider Business Mailing Address Fax Number:
240-846-4190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4061 POWDER MILL RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
CALVERTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20705-3149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-669-8501
Provider Business Practice Location Address Fax Number:
240-846-4190
Provider Enumeration Date:
10/23/2005

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: 2085R0202X , with the licence number:  MD14965 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: D37411 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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