Provider Demographics
NPI:1225244056
Name:MCCULLOCH, BIRGITTA MARTA (MD)
Entity Type:Individual
Prefix:
First Name:BIRGITTA
Middle Name:MARTA
Last Name:MCCULLOCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W BROAD ST
Mailing Address - Street 2:2200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23284-9089
Mailing Address - Country:US
Mailing Address - Phone:804-828-2470
Mailing Address - Fax:804-828-6688
Practice Address - Street 1:1300 W BROAD ST
Practice Address - Street 2:SUITE 2200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23284-9089
Practice Address - Country:US
Practice Address - Phone:804-828-2470
Practice Address - Fax:804-828-6688
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0123456789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine