Provider Demographics
NPI:1861577553
Name:ISBELL, BERGINA BRICKHOUSE (MD)
Entity type:Individual
Prefix:
First Name:BERGINA
Middle Name:BRICKHOUSE
Last Name:ISBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BERGINIA
Other - Middle Name:LAMONDA
Other - Last Name:BRICKHOUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6500
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-6500
Mailing Address - Country:US
Mailing Address - Phone:507-533-5441
Mailing Address - Fax:844-511-6928
Practice Address - Street 1:3355 SAINT JOHNS LN STE F
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2600
Practice Address - Country:US
Practice Address - Phone:507-533-5433
Practice Address - Fax:844-511-6928
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011136642084P0800X
MN491122084P0800X
DCMD0397962084P0800X
PAMD4379612084P0800X
CAC1508112084P0800X
MDD836092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
I65482Medicare UPIN