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NPI Code Detail

MEDICARE: JUSTIN CLARK BROCKBANK MD

MEDICARE: JUSTIN CLARK BROCKBANK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12080P0214XPediatric Pulmonology Physician0101243493VA
22080S0012XPediatric Sleep Medicine Physician0101243493VA

General Provider Information

NPI Number : 1396954699
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN CLARK BROCKBANK MD
Provider Business Mailing Address
First Line : 7300 ASHLAKE PKWY STE 200
Second Line :
City : CHESTERFIELD
State : VA
Zip : 23832-2827
Country : US
Telephone Number : 804-256-8282
Fax Number : 804-256-8288
Provider Business Practice Location Address
First Line : 7300 ASHLAKE PKWY STE 200
Second Line :
City : CHESTERFIELD
State : VA
Zip : 23832-2827
Country : US
Telephone Number : 804-256-8282
Fax Number : 804-256-8288
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2007
Last Update Date : 12/12/2025

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Directions to “ JUSTIN CLARK BROCKBANK MD” Practice Location

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