Provider Demographics
NPI:1134122138
Name:BRIELOFF, PETER NEIL (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:NEIL
Last Name:BRIELOFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14010 SMOKETOWN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4723
Mailing Address - Country:US
Mailing Address - Phone:703-583-5959
Mailing Address - Fax:
Practice Address - Street 1:14010 SMOKETOWN RD STE 103
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4723
Practice Address - Country:US
Practice Address - Phone:703-583-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01208213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD355698100Medicaid
MD483CMedicare PIN
MD355698100Medicaid
WVBR0825543Medicare PIN