Healthcare Provider Details

I. General information

NPI: 1841741089
Provider Name (Legal Business Name): INFECTIOUS DISEASE ASSOCIATES OF CENTRAL VIRGINIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 LANDOVER PL
LYNCHBURG VA
24501-2115
US

IV. Provider business mailing address

2215 LANDOVER PL
LYNCHBURG VA
24501-2115
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-3944
  • Fax: 434-544-2337
Mailing address:
  • Phone: 434-947-3944
  • Fax: 434-544-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT O BRENNAN
Title or Position: PRESIDENT
Credential: MD
Phone: 434-947-3944