MEDICARE: RICHARD K BRANTLEY JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101059074	VA

General Provider Information

NPI Number	:	1912987728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD K BRANTLEY JR. MD

Provider Business Mailing Address
First Line	:	908 E JEFFERSON ST STE G1
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-5375
Country	:	US
Telephone Number	:	434-244-5684
Fax Number	:

Provider Business Practice Location Address
First Line	:	908 E JEFFERSON ST STE G1
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-5375
Country	:	US
Telephone Number	:	434-244-5684
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	04/07/2025

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