1306976063 NPI number — MRS. JUNE ELIZABETH BREINER M.D.

Table of content: MRS. JUNE ELIZABETH BREINER M.D. (NPI 1306976063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306976063 NPI number — MRS. JUNE ELIZABETH BREINER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BREINER
Provider First Name:
JUNE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1306976063
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1205 YORK RD STE 25B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUTHERVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21093-6222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-823-1191
Provider Business Mailing Address Fax Number:
410-823-1194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 YORK RD
Provider Second Line Business Practice Location Address:
SUITE 32C
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-6210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-823-1191
Provider Business Practice Location Address Fax Number:
410-823-1194
Provider Enumeration Date:
03/06/2007

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: 207R00000X , with the licence number:  D0040208 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: JB0880761 . This is a "INTERNAL MEDICINE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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