Healthcare Provider Details

I. General information

NPI: 1134122138
Provider Name (Legal Business Name): PETER NEIL BRIELOFF DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14010 SMOKETOWN RD STE 103
WOODBRIDGE VA
22192-4723
US

IV. Provider business mailing address

14010 SMOKETOWN RD STE 103
WOODBRIDGE VA
22192-4723
US

V. Phone/Fax

Practice location:
  • Phone: 703-583-5959
  • Fax:
Mailing address:
  • Phone: 703-583-5959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number01208
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: