Provider Demographics
NPI:1104401132
Name:FLAHERTY, BRETT SERPIS (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:SERPIS
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 TOMCAT BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23460-2188
Mailing Address - Country:US
Mailing Address - Phone:757-953-3779
Mailing Address - Fax:757-953-3810
Practice Address - Street 1:1550 TOMCAT BLVD STE 150
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23460-2188
Practice Address - Country:US
Practice Address - Phone:757-953-3779
Practice Address - Fax:757-953-3810
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101275832171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program