Provider Demographics
NPI:1992752356
Name:BRISLIN, BRIAN THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:THOMAS
Last Name:BRISLIN
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 1:233 COLLEGE AVE.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3384
Mailing Address - Country:US
Mailing Address - Phone:717-358-0800
Mailing Address - Fax:717-358-0803
Practice Address - Street 1:233 COLLEGE AVE.
Practice Address - Street 2:SUITE 201
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3384
Practice Address - Country:US
Practice Address - Phone:717-358-0800
Practice Address - Fax:717-358-0803
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423772207X00000X
GA070349207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
BB8649139OtherDEA
PA111958FKKMedicare PIN