Basic Information
| Provider Information | |||||||||
| NPI: | 1821285198 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MESSINA | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2411 WEST BELVEDERE AVE | ||||||||
| Address2: | SINAI HOSPITAL, LIFEBRIDGE HEALTH | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106019030 | ||||||||
| FaxNumber: | 4106017464 | ||||||||
| Practice Location | |||||||||
| Address1: | 2411 W BELVEDERE AVE | ||||||||
| Address2: | 206 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212155228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106019030 | ||||||||
| FaxNumber: | 4106017464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2007 | ||||||||
| LastUpdateDate: | 03/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | C0001383 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1821285198 | 01 | MD | NPI | OTHER |