Provider Demographics
NPI:1528063161
Name:BRYNIARSKI, MARK (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:BRYNIARSKI
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 1:201 CEDAR ST SE
Mailing Address - Street 2:STE 5630
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4920
Mailing Address - Country:US
Mailing Address - Phone:505-727-5910
Mailing Address - Fax:505-727-5939
Practice Address - Street 1:500 WALTERS ST NE
Practice Address - Street 2:STE 401
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2563
Practice Address - Country:US
Practice Address - Phone:505-727-5910
Practice Address - Fax:505-727-5939
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ62063207T00000X
NM97-21207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28919826OtherMEDICAID GROUP NUMBER
CODG3723OtherRAILROAD MEDICARE GROUP NUMBER
CO73926337OtherMEDICAID PRACTICE NUMBER
CO31901751Medicaid
CO348308OtherMEDICARE GROUP NUMBER
NM97-21OtherNM LICENSE
COC810213OtherMEDICARE GROUP NUMBER
COC810213OtherMEDICARE GROUP NUMBER
NM97-21OtherNM LICENSE
COP00623368Medicare PIN