Basic Information
| Provider Information | |||||||||
| NPI: | 1164438560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARMODY | ||||||||
| FirstName: | BRENNAN | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5855 BREMO RD | ||||||||
| Address2: | SUITE 506 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232261930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042853225 | ||||||||
| FaxNumber: | 8042850360 | ||||||||
| Practice Location | |||||||||
| Address1: | 5855 BREMO RD | ||||||||
| Address2: | SUITE 506 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232261930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042853225 | ||||||||
| FaxNumber: | 8042850360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 03/12/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 0101052856 | VA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | C06695 | 01 | VA | GROUP PTAN | OTHER |