Provider Demographics
NPI:1972743912
Name:BRIAN C. DE MUTH, M.D., PA
Entity type:Organization
Organization Name:BRIAN C. DE MUTH, M.D., PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DE MUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-869-0234
Mailing Address - Street 1:210 CHESAPEAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6395
Mailing Address - Country:US
Mailing Address - Phone:410-398-3868
Mailing Address - Fax:410-620-3686
Practice Address - Street 1:900 W BALTIMORE PIKE STE 101
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9313
Practice Address - Country:US
Practice Address - Phone:610-869-0234
Practice Address - Fax:610-869-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431985207X00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA133537Medicare PIN
MD060MMedicare PIN
MDUPIN G31808Medicare UPIN
MD058MMedicare PIN