Basic Information
| Provider Information | |||||||||
| NPI: | 1073547097 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BREINIG | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7400 LYNN AVE | ||||||||
| Address2: | |||||||||
| City: | HAMLIN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255231138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048245806 | ||||||||
| FaxNumber: | 3048245885 | ||||||||
| Practice Location | |||||||||
| Address1: | 1563 SAND PLANT RD | ||||||||
| Address2: | |||||||||
| City: | SOUTH CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253096120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047561500 | ||||||||
| FaxNumber: | 3047561548 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 08/26/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2066 | WV | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 34.009487 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001880346 | 01 | MOUNTAIN STATE BCBS | OTHER | P00359256 | 01 | OH | MEDICARE RAILROAD | OTHER | P00749570 | 01 | WV | RAILROAD MEDICARE | OTHER | 3810005861 | 05 | WV | MEDICAID | 2667118 | 05 | OH | MEDICAID |