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General NPI Number Information
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NPI Number | 1265941876
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Entity Type | Individual
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Provider Name | BRIAN DERNER
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Gender | Male
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 6455 LAKE MEADOW DR
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City | BURKE
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State | VA
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Zip | 22015-3935
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Country | US
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Telephone | 703-930-5105
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Fax | 703-930-5105
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Provider Business Mailing Address
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Address Line | 6455 LAKE MEADOW DR
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City | BURKE
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State | VA
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Zip | 22015-3935
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Country | US
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Telephone | 703-930-5105
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 1000
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E5878
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License Number State | CA
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