Healthcare Provider Details

I. General information

NPI: 1730339029
Provider Name (Legal Business Name): MR. BRENDAN WILLIAM MCCARTHY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 BALLAHACK RD STE 100
CHESAPEAKE VA
23322-2463
US

IV. Provider business mailing address

1035 NIDER BLVDR STE 100 ADMIRAL JOEL T. BOONE BRANCH HEALTH CLINIC
VIRGINIA BEACH VA
23459-2341
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-6259
  • Fax:
Mailing address:
  • Phone: 757-953-8154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: