Healthcare Provider Details

I. General information

NPI: 1073070298
Provider Name (Legal Business Name): PETER BRESLIN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2019
Last Update Date: 02/24/2019
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

4902 EVELYN BYRD RD
RICHMOND VA
23225-3102
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 TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER B BRESLIN
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 804-495-8661