Healthcare Provider Details

I. General information

NPI: 1700346764
Provider Name (Legal Business Name): MARC PHILIP BREIDENBAUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 ROLKIN CT STE 102
CHARLOTTESVILLE VA
22911-3643
US

IV. Provider business mailing address

PO BOX 603725
CHARLOTTE NC
28260-3725
US

V. Phone/Fax

Practice location:
  • Phone: 434-951-2191
  • Fax: 434-977-0200
Mailing address:
  • Phone: 828-575-2625
  • Fax: 828-350-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number0101274577
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: