Provider Demographics
NPI:1174543714
Name:BREINER, MICHAEL JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:BREINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2965 COLONNADE DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3557
Mailing Address - Country:US
Mailing Address - Phone:540-989-6361
Mailing Address - Fax:540-989-8697
Practice Address - Street 1:2965 COLONNADE DR
Practice Address - Street 2:SUITE 140
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3557
Practice Address - Country:US
Practice Address - Phone:540-989-6361
Practice Address - Fax:540-989-8697
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050226208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
348227OtherMAMSI
323954OtherANTHEM
4420846OtherAETNA
VA06901051Medicaid
76991OtherSOUTHERN HEALTH
4420846OtherAETNA