Provider Demographics
NPI:1215921580
Name:BRAUNSTEIN, PAUL W II (MD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:W
Last Name:BRAUNSTEIN
Suffix:II
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 1:1417 BATTLEFIELD BLVD N
Mailing Address - Street 2:SUITE 180
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4516
Mailing Address - Country:US
Mailing Address - Phone:757-491-6464
Mailing Address - Fax:757-491-6469
Practice Address - Street 1:1417 BATTLEFIELD BLVD N
Practice Address - Street 2:SUITE 180
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4516
Practice Address - Country:US
Practice Address - Phone:757-491-6464
Practice Address - Fax:757-491-6469
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044559174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007400951Medicaid
VIAETNAOtherAETNA PROVIDER NO.
VA1701294OtherUNITED HEALTHCARE PROVIDE
VA453902OtherANTHEM PROVIDER NO
NC007400951OtherN.C.MEDICAID PROVIDER #
VAMAMSIOtherMAMSI PROVIDER #
GA020037789OtherR.R. MEDICARE PROVIDER
VA37143OtherOPTIMA PROVIDER #
VA453902OtherANTHEM PROVIDER NO
VAE48446Medicare UPIN