1053542969 NPI number — BENJAMIN MICHAEL MCANDREWS MS, ATC, NASM-CES

Table of content: BENJAMIN MICHAEL MCANDREWS MS, ATC, NASM-CES (NPI 1053542969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053542969 NPI number — BENJAMIN MICHAEL MCANDREWS MS, ATC, NASM-CES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCANDREWS
Provider First Name:
BENJAMIN
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, ATC, NASM-CES
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:
1053542969
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4608 GALEFORCE CT APT 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23455-2041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-619-5213
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
828 HEALTHY WAY STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23462-7958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-463-2540
Provider Business Practice Location Address Fax Number:
757-463-2554
Provider Enumeration Date:
07/28/2009

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: 2255A2300X , with the licence number:  0126001207 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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