Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 0101033931 | VA |
NPI | 1033286141 |
---|---|
Provider Name | Dr. Kurt T Brandt |
First Address | Oakton, VA 22124-1802 |
Second Address | Alexandria, VA 22314-1912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
299093 | AMERIGROUP VIRGINIA, INC. (01) | VA |
E54679 | (02) | VA |