Provider Demographics
NPI:1114098332
Name:BRISCOE, PHILANDER BOWEN (MD)
Entity type:Individual
Prefix:DR
First Name:PHILANDER
Middle Name:BOWEN
Last Name:BRISCOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:520 UPPER CHESAPEAKE DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4339
Mailing Address - Country:US
Mailing Address - Phone:410-879-9100
Mailing Address - Fax:410-879-0227
Practice Address - Street 1:520 UPPER CHESAPEAKE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4339
Practice Address - Country:US
Practice Address - Phone:410-879-9100
Practice Address - Fax:410-879-0227
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0001318207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
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MD25164OtherEHP
MD39909003OtherCAREFIRST
MD103438OtherKAISER
MDP00282834OtherRAILROAD MEDICARE
MD026031200Medicaid
MD317866OtherMAMSI
MD3529111OtherAETNA HMO
MD4328636OtherAETNA PPO
DCE5130010OtherCAREFIRST BLUECHOICE
MDP00282834OtherRAILROAD MEDICARE
MDC48945Medicare UPIN