Provider Demographics
NPI:1154379287
Name:BRANTZ, ARTHUR (MD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:
Last Name:BRANTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8735 SHADOW LAWN CT
Mailing Address - Street 2:
Mailing Address - City:ANNADALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003
Mailing Address - Country:US
Mailing Address - Phone:703-323-5608
Mailing Address - Fax:
Practice Address - Street 1:6020 RICHMOND HIGHWAY
Practice Address - Street 2:102
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22303
Practice Address - Country:US
Practice Address - Phone:571-308-6776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035318208D00000X
DCMD33444174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
B93865Medicare UPIN
017312W59Medicare ID - Type Unspecified