Basic Information
| Provider Information | |||||||||
| NPI: | 1154371482 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLAUN | ||||||||
| FirstName: | BRAEME | ||||||||
| MiddleName: | SEYMOUR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2401 W BELVEDERE AVE | ||||||||
| Address2: | ATTN: CREDENTIALING | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212155216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106015524 | ||||||||
| FaxNumber: | 4106018946 | ||||||||
| Practice Location | |||||||||
| Address1: | MICHEL MIROWSKI, MD, OFF. BLDG | ||||||||
| Address2: | 5051 GREENSPRING AVENUE | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106019515 | ||||||||
| FaxNumber: | 4106018905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 11/28/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | D59171 | MD | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | C31152 | 01 | MD | R/R MEDICARE GROUP # | OTHER | P00125518 | 01 | MD | R/R MEDICARE PROVIDER # | OTHER |