Provider Demographics
NPI:1154359792
Name:BRENGEL, GEORGE R (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:BRENGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9220 FOREST HILL AVE
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6800
Mailing Address - Country:US
Mailing Address - Phone:804-560-8838
Mailing Address - Fax:804-560-3527
Practice Address - Street 1:9220 FOREST HILL AVE
Practice Address - Street 2:SUITE 1-A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-6800
Practice Address - Country:US
Practice Address - Phone:804-560-8838
Practice Address - Fax:804-560-3527
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101031183207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA272177OtherMAMSI
VA113448OtherSOUTHERN HEALTH SERVICES
VA45862OtherSENTARA
VA5430444OtherAETNA HMO
VA110199910OtherRAILROAD MEDICARE
VA9213100OtherCIGNA
VA010016452Medicaid
VA214490OtherANTHEM BCBS OF VA
VA5430444OtherAETNA LIFE
VAC06778OtherGROUP PTAN
VA110199910OtherRAILROAD MEDICARE
VA214490OtherANTHEM BCBS OF VA