Provider Demographics
NPI:1760538979
Name:GARIBALDI, BRIAN T (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:GARIBALDI
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:PO BOX 64264
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4264
Mailing Address - Country:US
Mailing Address - Phone:410-955-3467
Mailing Address - Fax:
Practice Address - Street 1:676 N SAINT CLAIR ST STE 2100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2993
Practice Address - Country:US
Practice Address - Phone:312-695-1800
Practice Address - Fax:312-695-4741
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036171042207RP1001X
MDD66256207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD017332100Medicaid
MDKR65S928Medicare PIN
MD159525YVBMedicare PIN