Provider Demographics
NPI:1407910433
Name:BUDENHOLZER, BRIAN R (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:BUDENHOLZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:EVMS MEDICAL GROUP
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5955
Mailing Address - Fax:757-446-5196
Practice Address - Street 1:3640 HIGH ST STE 3B
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3213
Practice Address - Country:US
Practice Address - Phone:757-397-6344
Practice Address - Fax:757-606-1185
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255216207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-003OtherTRICARE/CHAMPUS
VAPAROtherMULTIPLAN
VA1407910433OtherCOVENTRY NETWORK
VA1407910433OtherUNITED HEALTHCARE
VA10119386OtherOPTIMA HEALTH
VAPAROtherCORVEL
NC1407910433Medicaid
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherCIGNA
VA505540OtherANTHEM BC/BS
VAPAROtherUSA MANAGED CARE
VAPAROtherAETNA
VA1407910433Medicaid
VA1407910433OtherVIRGINIA PREMIER HEALTH PLAN
VA1407910433OtherCOVENTRY NETWORK
VAVVC141AMedicare PIN
VAP01304579Medicare PIN