Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 0101233443 | VA |
N | 208200000X | Surgeon | 0101233443 | VA |
N | 208600000X | Surgeon | 0101233443 | VA |
NPI | 1306915921 |
---|---|
Provider Name | Kenneth L. Brayman |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Charlottesville, VA 22908-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 06/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007313306 | (05) | VA |
E97391 | (02) | VA |