Provider Demographics
NPI:1407869217
Name:MONDELL, BRIAN E (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:E
Last Name:MONDELL
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 1:724 LIGHT ST STE A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-3813
Mailing Address - Country:US
Mailing Address - Phone:443-869-5641
Mailing Address - Fax:443-869-5642
Practice Address - Street 1:724 LIGHT ST STE A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-3813
Practice Address - Country:US
Practice Address - Phone:443-869-5461
Practice Address - Fax:443-869-5642
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00324962084N0400X, 2084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE00537Medicare UPIN