Provider Demographics
NPI:1215963715
Name:BITTNER, BRIAN C (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:C
Last Name:BITTNER
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 1:5416 HILLSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7143
Mailing Address - Country:US
Mailing Address - Phone:804-449-1717
Mailing Address - Fax:
Practice Address - Street 1:5416 HILLSHIRE WAY
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-7143
Practice Address - Country:US
Practice Address - Phone:804-449-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA205980OtherSOUTHERN HEALTH SERVICES
VAP00111971OtherRAILROAD MEDICARE
VA005644054Medicaid
VA8123822OtherCIGNA
VA237455OtherANTHEM BCBS OF VA
VA759396OtherAETNA LIFE
VA57485OtherSENTARA
VA280091OtherMAMSI
VA759396OtherAETNA HMO
VA759396OtherAETNA HMO
000729B41Medicare ID - Type Unspecified