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General NPI Number Information
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NPI Number | 1255865275
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Entity Type | Individual
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Provider Name | BRANDON M LEWKO MD
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Gender | Male
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 60 PROSPERITY LN STE 500
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City | STAFFORD
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State | VA
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Zip | 22556-4605
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Country | US
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Telephone | 540-658-2811
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Fax | 681-342-3625
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Provider Business Mailing Address
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Address Line | 5000 COX RD
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City | GLEN ALLEN
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State | VA
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Zip | 23060-9263
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Country | US
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Telephone | 804-968-5700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD470646
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101272463
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License Number State | VA
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