Provider Demographics
NPI:1699718379
Name:BIRRIEL, LARRY K (DPM)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:K
Last Name:BIRRIEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 PORTER ST
Mailing Address - Street 2:FORT DETRICK ARMY GARRISON
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-9211
Mailing Address - Country:US
Mailing Address - Phone:301-624-1200
Mailing Address - Fax:240-379-7013
Practice Address - Street 1:1433 PORTER ST
Practice Address - Street 2:FORT DETRICK ARMY GARRISON
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-9211
Practice Address - Country:US
Practice Address - Phone:301-624-1200
Practice Address - Fax:240-379-7013
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003204L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery