Provider Demographics
NPI:1073547097
Name:BREINIG, ADAM J (DO)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:J
Last Name:BREINIG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1138
Mailing Address - Country:US
Mailing Address - Phone:304-824-5806
Mailing Address - Fax:304-824-5885
Practice Address - Street 1:1563 SAND PLANT RD
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-6120
Practice Address - Country:US
Practice Address - Phone:304-756-1500
Practice Address - Fax:304-756-1548
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2066207Q00000X
OH34.009487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
001880346OtherMOUNTAIN STATE BCBS
OHP00359256OtherMEDICARE RAILROAD
WVP00749570OtherRAILROAD MEDICARE
WV3810005861Medicaid
OH2667118Medicaid
WV3810005861Medicaid