Healthcare Provider Details

I. General information

NPI: 1063582484
Provider Name (Legal Business Name): BRAUNSTEIN SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 BATTLEFIELD BLVD N SUITE 180
CHESAPEAKE VA
23320-4516
US

IV. Provider business mailing address

1417 BATTLEFIELD BLVD N SUITE 180
CHESAPEAKE VA
23320-4516
US

V. Phone/Fax

Practice location:
  • Phone: 757-491-6467
  • Fax: 757-491-6469
Mailing address:
  • Phone: 757-491-6467
  • Fax: 757-491-6469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101 044559
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number0101 044559
License Number StateVA

VIII. Authorized Official

Name: MRS. DENICE TARRANT
Title or Position: OFFICE MANAGER
Credential:
Phone: 757-491-6467