Basic Information
| Provider Information | |||||||||
| NPI: | 1316011406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCANDREW | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.M.D., M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1035 IRENES PETITE CT | ||||||||
| Address2: | |||||||||
| City: | FOREST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245514598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4345250050 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 ARCHWAY CT | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245022890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4348328040 | ||||||||
| FaxNumber: | 4348328041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 1223S0112X | 0401410446 | VA | X | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 1223S0112X | 0438000151 | VA | X | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 204E00000X | 0101229768 | VA | X | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery |
ID Information
| ID | Type | State | Issuer | Description | 9179585 | 05 | VA | MEDICAID |