Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 0101237413 | VA |
N | 207ND0900X | Dermatopathologist | 0101237413 | VA |
N | 207NS0135X | Procedural Dermatology | 0101237413 | VA |
NPI | 1386612547 |
---|---|
Provider Name | Brett Douglas Krasner |
First Address | Charlottesville, VA 22911-4631 |
Second Address | Charlottesville, VA 22911-4631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 30/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010163226 | (05) | VA |
178139 | BCBS (01) | |
I13149 | (02) |