Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | D87742 | MD |
NPI | 1346483070 |
---|---|
Provider Name | Mr. Brian Robert Englum |
First Address | Baltimore, MD 21264-4226 |
Second Address | Baltimore, MD 21201-1544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2009 |
Last Update Date | 06/09/2019 |