MEDICARE: DR. BRIAN M WASSERMAN M.D.

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	207R00000X	Internal Medicine Physician	0101026634	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730188905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN M WASSERMAN M.D.

Provider Business Mailing Address
First Line	:	1475 JOHNSTON WILLIS DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4730
Country	:	US
Telephone Number	:	804-272-7564
Fax Number	:	804-272-9325

Provider Business Practice Location Address
First Line	:	1475 JOHNSTON WILLIS DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4730
Country	:	US
Telephone Number	:	804-272-7564
Fax Number	:	804-272-9325

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	06/06/2014

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