Healthcare Provider Details

I. General information

NPI: 1114288529
Provider Name (Legal Business Name): PETER B BRESLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2012
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 FALMOUTH ST STE 103
RICHMOND VA
23230-1800
US

IV. Provider business mailing address

5540 FALMOUTH STREET SUITE 103
RICHMOND VA
23230
US

V. Phone/Fax

Practice location:
  • Phone: 804-495-8661
  • Fax: 804-486-9819
Mailing address:
  • Phone: 804-495-8661
  • Fax: 804-486-9819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number0101256720
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101256720
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: