Healthcare Provider Details

I. General information

NPI: 1861467847
Provider Name (Legal Business Name): KILIAN H. BRECH II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 HIGHLAND AVE SE STE 100
ROANOKE VA
24013
US

IV. Provider business mailing address

21 HIGHLAND AVE SE STE 100
ROANOKE VA
24013-2218
US

V. Phone/Fax

Practice location:
  • Phone: 540-344-9213
  • Fax: 540-345-7559
Mailing address:
  • Phone: 540-344-9213
  • Fax: 540-345-7559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD073280L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101256805
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: