Provider Demographics
NPI:1619933447
Name:BRINK, WILLIAM CLARENCE (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CLARENCE
Last Name:BRINK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:190 CAMPUS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2872
Mailing Address - Country:US
Mailing Address - Phone:540-662-6135
Mailing Address - Fax:540-662-5845
Practice Address - Street 1:190 CAMPUS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2872
Practice Address - Country:US
Practice Address - Phone:540-662-6135
Practice Address - Fax:540-662-5845
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101054044207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC00085OtherMEDICARE GROUP
2119631OtherMAMSI PROFESSIONAL
WV3810003817OtherWV MEDICAID GROUP
WV000433417OtherWV BLUE SHIELD
43936OtherSENTARA PROFESSIONAL
VA006051987Medicaid
08243600000OtherQUALCHOICE PROFESSIONAL
WV0079497000Medicaid
211017OtherANTHEM PROFESSIONAL
WV000433417OtherWV BLUE SHIELD
WV3810003817OtherWV MEDICAID GROUP