Basic Information
| Provider Information | |||||||||
| NPI: | 1669595278 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRESNER | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 N. BEAUREGARD ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038451500 | ||||||||
| FaxNumber: | 7038451300 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 N. BEAUREGARD ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038451500 | ||||||||
| FaxNumber: | 7038451300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 09/10/2009 | ||||||||
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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 | 2084N0400X | 0101243890 | VA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 1669595278 | 05 | VA | MEDICAID |