Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 0401410446 | VA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 0438000151 | VA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 0101229768 | VA |
NPI | 1316011406 |
---|---|
Provider Name | Dr. Brian Patrick Mcandrew |
First Address | Forest, VA 24551-4598 |
Second Address | Lynchburg, VA 24502-2890 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9179585 | (05) | VA |