Individual
BRIAN W MANDEVILLE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2215 LANDOVER PL, LYNCHBURG, VA 24501-2115
(434) 947-3944
(866) 617-8273
Mailing address
2215 LANDOVER PL, LYNCHBURG, VA 24501-2115
(434) 947-3944
(866) 617-8273
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101239244
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356683957
—
VA
Enumeration date
03/21/2013
Last updated
10/16/2013
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