Healthcare Provider Details

I. General information

NPI: 1184674251
Provider Name (Legal Business Name): JUDY LYNN BRANNEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

1916 APPLE RIDGE CT
RICHMOND VA
23229-4162
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5511
  • Fax: 804-675-5250
Mailing address:
  • Phone: 804-282-8937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number0101039646
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: