Provider Demographics
NPI:1386612547
Name:KRASNER, BRETT DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:DOUGLAS
Last Name:KRASNER
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 1:215 WAYLES LN STE 150
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-4631
Mailing Address - Country:US
Mailing Address - Phone:434-964-9500
Mailing Address - Fax:434-964-9501
Practice Address - Street 1:215 WAYLES LN STE 150
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4631
Practice Address - Country:US
Practice Address - Phone:434-964-9500
Practice Address - Fax:434-964-9501
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237413207ND0900X, 207NI0002X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
178139OtherBCBS
VA010163226Medicaid
178139OtherBCBS
C09506Medicare ID - Type Unspecified