Provider Demographics
NPI:1932100104
Name:BREHMER, CHARLES EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWARD
Last Name:BREHMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:909 HIOAKS RD
Mailing Address - Street 2:STE J
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4038
Mailing Address - Country:US
Mailing Address - Phone:804-320-6762
Mailing Address - Fax:804-320-6599
Practice Address - Street 1:909 HIOAKS RD
Practice Address - Street 2:STE J
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4038
Practice Address - Country:US
Practice Address - Phone:804-320-6762
Practice Address - Fax:804-320-6599
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101025106208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005619769Medicaid
VA0101025106OtherMEDICAL LICENSE
VAB09140Medicare UPIN
VA005619769Medicaid