Healthcare Provider Details

I. General information

NPI: 1639197346
Provider Name (Legal Business Name): BRIAN SCOTT UTHLAUT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 JEFFERSON PARK AVE FL 3
CHARLOTTESVILLE VA
22908-0001
US

IV. Provider business mailing address

500 RAY C HUNT DR
CHARLOTTESVILLE VA
22903-2981
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-1931
  • Fax: 434-924-1138
Mailing address:
  • Phone: 434-980-6140
  • Fax: 434-972-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101239742
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: