Provider Demographics
NPI:1477547016
Name:BRNA, THEODORE GEORGE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:GEORGE
Last Name:BRNA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6321 DEANS ST
Mailing Address - Street 2:P. O. BOX 280
Mailing Address - City:BAILEY
Mailing Address - State:NC
Mailing Address - Zip Code:27807-8641
Mailing Address - Country:US
Mailing Address - Phone:252-235-4181
Mailing Address - Fax:252-235-2950
Practice Address - Street 1:6321 DEANS ST
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:NC
Practice Address - Zip Code:27807-8641
Practice Address - Country:US
Practice Address - Phone:252-235-4181
Practice Address - Fax:252-235-2950
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0159HOtherBLUE CROSS BLUE SHEILD OF NC
NC7918535Medicaid
NC080032784OtherRAILROAD MEDICARE
NC0159HOtherBLUE CROSS BLUE SHEILD OF NC
NC2732428AMedicare ID - Type UnspecifiedGROUP
NC7918535Medicaid