Basic Information
Provider Information
NPI: 1629283692
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARRETT
FirstName: BRANDON
MiddleName: JON
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 220 CAMPUS BLVD STE 100
Address2:  
City: WINCHESTER
State: VA
PostalCode: 226012896
CountryCode: US
TelephoneNumber: 5405365100
FaxNumber: 5405360235
Practice Location
Address1: 1880 AMHERST STREET
Address2: SUITE 100 AND SUITE 200
City: WINCHESTER
State: VA
PostalCode: 226012872
CountryCode: US
TelephoneNumber: 5406620306
FaxNumber: 8552642066
Other Information
ProviderEnumerationDate: 05/13/2007
LastUpdateDate: 09/14/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/14/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X0101248727VAN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RI0011X02671WVN Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
207RI0011X0101248727VAY Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology

No ID Information.


Home