Organization
SOUTHWEST VIRGINIA CENTER FOR COSMETIC PLASTIC & RECON SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL J BREINER M.D. (PRESIDENT)
(540) 989-6361
Entity
Organization
Contact information
Practice address
2965 COLONNADE DRIVE, SUITE 140, ROANOKE, VA 24018-3541
(540) 989-6361
(540) 989-6361
Mailing address
2965 COLONNADE DRIVE, SUITE 140, ROANOKE, VA 24018-3541
(540) 989-6361
(540) 989-8697
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0101050226
VA
208200000X
Plastic Surgery Physician
Primary
0101050226
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06901051
—
VA
01
—
089951000
QUAL CHOICE
—
01
—
240000224
UNITED HEALTHCARE
—
01
—
323954
ANTHEM
—
01
—
348227
MAMSI
—
01
—
76991
SOUTHERN HEALTH
—
01
—
AETNA
4420846
—
Enumeration date
10/19/2006
Last updated
04/11/2011
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