Provider Demographics
NPI:1336677913
Name:BRUNNER, BRIANA KATHLEEN (MD)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:KATHLEEN
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2661 RIVA RD STE 1030
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7131
Mailing Address - Country:US
Mailing Address - Phone:410-571-8733
Mailing Address - Fax:410-571-6309
Practice Address - Street 1:200 WASHINGTON HEIGHTS MED CTR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5633
Practice Address - Country:US
Practice Address - Phone:410-848-4095
Practice Address - Fax:410-848-5314
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-26
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT12210690-1205207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0116033489Medicaid