MEDICARE: MARC PHILIP BREIDENBAUGH 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
1	208000000X	Pediatrics Physician	0101274577	VA
2	207K00000X	Allergy & Immunology Physician	0101274577	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0101274577	OTHER	VA	VA LICENSE

General Provider Information

NPI Number	:	1700346764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC PHILIP BREIDENBAUGH MD

Provider Business Mailing Address
First Line	:	9920 INDEPENDENCE PARK DR STE 100
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23233-1487
Country	:	US
Telephone Number	:	804-726-5141
Fax Number	:	804-288-3150

Provider Business Practice Location Address
First Line	:	9920 INDEPENDENCE PARK DR STE 100
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23233-1487
Country	:	US
Telephone Number	:	804-285-7420
Fax Number	:	804-285-7454

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2019
Last Update Date	:	07/18/2024

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Directions to “ MARC PHILIP BREIDENBAUGH MD” Practice Location

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