Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 2011-00493 | NC |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 0101254888 | VA |
NPI | 1083822522 |
---|---|
Provider Name | Glenn M Brammer |
First Address | Fishersville, VA 22939-0388 |
Second Address | Fishersville, VA 22939-2332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 24/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5917838 | (05) | NC |