Basic Information
| Provider Information | |||||||||
| NPI: | 1245625979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACMILLAN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | VCUHS GMEA | ||||||||
| Address2: | BOX 980257 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232980257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048289783 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | VCUHS DEPT OF PULM/CRIT CARE BOX # 908509 | ||||||||
| Address2: | 1250 E MARSHALL STREET | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048283150 | ||||||||
| FaxNumber: | 8048283673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2015 | ||||||||
| LastUpdateDate: | 09/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34.012840 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | 0116032511 | VA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 0102205996 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0241008 | 05 | OH | MEDICAID |