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General NPI Number Information
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NPI Number | 1497441430
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Entity Type | Individual
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Provider Name | BRANDON EDWARD WOOLDRIDGE
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Gender | Male
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Dates
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Enumeration Date | 04/13/2023
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 582 BLUE RIDGE AVE
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City | BEDFORD
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State | VA
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Zip | 24523-2604
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Country | US
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Telephone | 540-425-7910
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Fax | 540-583-5419
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Provider Business Mailing Address
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Address Line | 1193 MARKET DR
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City | GOODE
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State | VA
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Zip | 24556-2708
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Country | US
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Telephone | 434-401-2196
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110009594
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License Number State | VA
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