Healthcare Provider Details

I. General information

NPI: 1336167741
Provider Name (Legal Business Name): JAMES F BRENNAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 POCOSHOCK PL SUITE 302
RICHMOND VA
23235-6345
US

IV. Provider business mailing address

2500 POCOSHOCK PL SUITE 302
RICHMOND VA
23235-6345
US

V. Phone/Fax

Practice location:
  • Phone: 804-674-1985
  • Fax: 804-276-1048
Mailing address:
  • Phone: 804-674-1985
  • Fax: 804-276-1048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number0101028784
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: