Healthcare Provider Details

I. General information

NPI: 1386613495
Provider Name (Legal Business Name): GEORGE C BRANCHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S SHIRLINGTON RD STE 1100
ARLINGTON VA
22206-3605
US

IV. Provider business mailing address

2800 S SHIRLINGTON RD STE 1000
ARLINGTON VA
22206-3614
US

V. Phone/Fax

Practice location:
  • Phone: 703-769-8450
  • Fax: 703-271-9451
Mailing address:
  • Phone: 703-769-8450
  • Fax: 703-271-9451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101041029
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number0101041029
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: