MEDICARE: DR. ROBERT BRICHTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	0101048029	VA

General Provider Information

NPI Number	:	1386648301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT BRICHTA MD

Provider Business Mailing Address
First Line	:	PO BOX 636
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-0636
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7016 LEE PARK RD
Second Line	:	SUITE 100
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-3682
Country	:	US
Telephone Number	:	804-730-2652
Fax Number	:	804-559-3067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	08/11/2009

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