Provider Demographics
NPI:1013948488
Name:BYRNE, JOHN PHILIP (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PHILIP
Last Name:BYRNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8926 WOODYARD ROAD
Mailing Address - Street 2:SUITE 701
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735
Mailing Address - Country:US
Mailing Address - Phone:301-856-1682
Mailing Address - Fax:301-856-0964
Practice Address - Street 1:8926 WOODYARD ROAD
Practice Address - Street 2:SUITE 701
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735
Practice Address - Country:US
Practice Address - Phone:301-856-1682
Practice Address - Fax:301-856-0964
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040832207X00000X
VA0101045693207X00000X
DCMD19079207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD200028340OtherRAILROAD MEDICARE
DC46950009OtherBCBS PROVIDER #
52 1054342OtherTAX ID #
MD462*LMedicare ID - Type UnspecifiedMARYLAND MEDICARE GRP#
MD0254450001Medicare NSC
DC176608Medicare ID - Type UnspecifiedMEDICARE METRO GRP PROV#
MD200028340OtherRAILROAD MEDICARE
VA0254450001Medicare NSC
DC46950009OtherBCBS PROVIDER #