Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 0101049670 | VA |
NPI | 1003834078 |
---|---|
Provider Name | Brantley P Vitek |
First Address | Baltimore, MD 21275-5868 |
Second Address | Mc Lean, VA 22102-3888 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6407251 | (05) | VA |
F82997 | (02) |