Provider Demographics
NPI:1891763447
Name:BREINER, ROBERT ANTHONY (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:BREINER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5105 BACKLICK RD
Mailing Address - Street 2:UNIT S
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6005
Mailing Address - Country:US
Mailing Address - Phone:703-941-7770
Mailing Address - Fax:703-941-7771
Practice Address - Street 1:5105 BACKLICK RD
Practice Address - Street 2:UNIT S
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6005
Practice Address - Country:US
Practice Address - Phone:703-941-7770
Practice Address - Fax:703-941-7771
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000805213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9301615Medicaid
VAT89078Medicare UPIN
VA410331Medicare ID - Type Unspecified