1033726088 NPI number — MR. BRADD ANDREW BUCKINGHAM MACMH

Table of content: MR. BRADD ANDREW BUCKINGHAM MACMH (NPI 1033726088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033726088 NPI number — MR. BRADD ANDREW BUCKINGHAM MACMH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCKINGHAM
Provider First Name:
BRADD
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MACMH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033726088
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 RIVERSIDE PARK WAY
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
FREDERICKSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-373-1200
Provider Business Mailing Address Fax Number:
540-373-1283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 RIVERSIDE PKWY STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22406-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-373-1200
Provider Business Practice Location Address Fax Number:
540-373-1283
Provider Enumeration Date:
09/24/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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