Provider Demographics
NPI:1194818310
Name:VAN BREDA, ARINA (MD)
Entity Type:Individual
Prefix:
First Name:ARINA
Middle Name:
Last Name:VAN BREDA
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:PO BOX 79537
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0537
Mailing Address - Country:US
Mailing Address - Phone:703-824-3200
Mailing Address - Fax:
Practice Address - Street 1:8001 FORBES PL
Practice Address - Street 2:SUITE 103
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-2208
Practice Address - Country:US
Practice Address - Phone:703-824-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010354022085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00122471OtherRAILROAD MEDICARE
300053684OtherRAILROAD MEDICARE
DC092154A25Medicare PIN
VA300002508Medicare PIN
A54819Medicare UPIN