Individual
MATTHEW LESTER BRENGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5855 BREMO RD, SUITE 406, RICHMOND, VA 23226-1930
(804) 285-4133
(804) 622-2224
Mailing address
5855 BREMO RD, SUITE 406, RICHMOND, VA 23226-1930
(804) 285-4133
(804) 622-2224
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101235980
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010074142
—
VA
01
—
C06695
GROUP PTAN
VA
01
—
C06778
GROUP PTAN
VA
Enumeration date
05/04/2006
Last updated
02/04/2022
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