Provider Demographics
NPI:1306455936
Name:PRECISIONBRAINMD,LLC
Entity type:Organization
Organization Name:PRECISIONBRAINMD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:COKER
Authorized Official - Suffix:
Authorized Official - Credentials:PROVIDER RELATIONS
Authorized Official - Phone:301-423-4551
Mailing Address - Street 1:2924 GUILFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-4115
Mailing Address - Country:US
Mailing Address - Phone:301-423-4551
Mailing Address - Fax:301-899-5153
Practice Address - Street 1:516 N ROLLING RD STE 203
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-4187
Practice Address - Country:US
Practice Address - Phone:443-916-2708
Practice Address - Fax:410-788-1577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty