Provider Demographics
NPI:1912987728
Name:BRANTLEY, RICHARD K JR (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:K
Last Name:BRANTLEY
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 1:908 E JEFFERSON ST STE G1
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5375
Mailing Address - Country:US
Mailing Address - Phone:434-244-5684
Mailing Address - Fax:
Practice Address - Street 1:908 E JEFFERSON ST STE G1
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5375
Practice Address - Country:US
Practice Address - Phone:434-244-5684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004170F82Medicare PIN
H26061Medicare UPIN
VAP00162738Medicare PIN