Healthcare Provider Details

I. General information

NPI: 1538587761
Provider Name (Legal Business Name): GRETCHEN ELDER BRAYMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GRETCHEN MICHELLE ELDER

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 COLISEUM DR STE 320
HAMPTON VA
23666-5983
US

IV. Provider business mailing address

6528 HARBOUR POINTE DR
SUFFOLK VA
23435-3180
US

V. Phone/Fax

Practice location:
  • Phone: 757-827-2350
  • Fax:
Mailing address:
  • Phone: 919-796-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101261582
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101261582
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: