Individual
MARC PHILIP BREIDENBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9920 INDEPENDENCE PARK DR STE 100, HENRICO, VA 23233-1487
(804) 285-7420
(804) 285-7454
Mailing address
9920 INDEPENDENCE PARK DR STE 100, HENRICO, VA 23233-1487
(804) 726-5141
(804) 288-3150
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
0101274577
VA
208000000X
Pediatrics Physician
0101274577
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101274577
VA LICENSE
VA
Enumeration date
03/24/2019
Last updated
07/18/2024
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