Active NPI
Robert Brull, M.D.
- Specialist
- Hagerstown, MD
National Provider Identifier
1639180169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- D 0004359
- Practice address
- 1459 Potomac Ave
Hagerstown, MD 21742-3315 - Phone
- (301) 791-5882
- Fax
- (301) 714-0632
- NPI assigned
- Aug 10, 2006
- Last updated
- Jan 3, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | D 0004359 | MD | Primary |
Addresses
Primary practice location
1459 Potomac Ave
Hagerstown, MD 21742-3315
Mailing address
1459 Potomac Ave
Hagerstown, MD 21742-3315
Phone (301) 791-5882
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 44775-1100 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D 0004359 | MD | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Frederick Health Hospital
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388707200000",
"number": "1639180169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1459 POTOMAC AVE",
"city": "HAGERSTOWN",
"state": "MD",
"postal_code": "217423315",
"telephone_number": "301-791-5882",
"fax_number": "301-714-0632"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1459 POTOMAC AVE",
"city": "HAGERSTOWN",
"state": "MD",
"postal_code": "217423315",
"telephone_number": "301-791-5882",
"fax_number": "301-714-0632"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRULL",
"first_name": "ROBERT",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-10",
"last_updated": "2014-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MD",
"license": "D 0004359",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "44775-1100",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hagerstown, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.