Healthcare Provider Details

I. General information

NPI: 1275389496
Provider Name (Legal Business Name): BRENDON MCCULLOUGH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED NATIONAL MILITARY MEDICAL CENTER 8901 WISCONSIN AVENUE
BETHESDA MD
20889
US

IV. Provider business mailing address

WALTER REED NATIONAL MILITARY MEDICAL CENTER 8901 WISCONSIN AVENUE
BETHESDA MD
20889
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102209493
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: