Provider Demographics
NPI:1063558385
Name:BREAKEY, WILLIAM RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RAYMOND
Last Name:BREAKEY
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 1:1002 METFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21286-1639
Mailing Address - Country:US
Mailing Address - Phone:410-321-1002
Mailing Address - Fax:
Practice Address - Street 1:JOHNS HOPKINS HOSPITAL
Practice Address - Street 2:600 NORTHE BROADWAY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0001
Practice Address - Country:US
Practice Address - Phone:410-955-5129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD193392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD77662Medicare UPIN