Organization
MARYLAND BRAIN SPINE & PAIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN J SULLIVAN M.D. (PRESIDENT/PHYSICIAN)
(410) 266-2720
Entity
Organization
Contact information
Practice address
4201 NORTHVIEW DR STE 101, BOWIE, MD 20716-2644
(410) 266-2720
(410) 224-0209
Mailing address
1000 BESTGATE RD STE 400, ANNAPOLIS, MD 21401-3371
(410) 266-2720
(443) 224-0209
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003QMA
BCBS
MD
05
—
404557200
—
MD
05
—
404557201
—
MD
01
—
D380
BCBS
DC
Enumeration date
03/11/2006
Last updated
11/29/2018
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