Provider Demographics
NPI:1992053482
Name:BRIETER T C
Entity type:Organization
Organization Name:BRIETER T C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLUHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-389-6910
Mailing Address - Street 1:115 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-4252
Mailing Address - Country:US
Mailing Address - Phone:804-389-6910
Mailing Address - Fax:
Practice Address - Street 1:115 S 15TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-4252
Practice Address - Country:US
Practice Address - Phone:804-389-6910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0105215784207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency MedicineGroup - Single Specialty