Provider Demographics
NPI:1871639658
Name:BRANDERMILL PEDIATRIC & ADOLESCENT MEDICINE PC
Entity Type:Organization
Organization Name:BRANDERMILL PEDIATRIC & ADOLESCENT MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCGHEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-744-1231
Mailing Address - Street 1:4902 MILLRIDGE PKWY E
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4828
Mailing Address - Country:US
Mailing Address - Phone:804-744-1231
Mailing Address - Fax:804-744-9521
Practice Address - Street 1:4902 MILLRIDGE PKWY E
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4828
Practice Address - Country:US
Practice Address - Phone:804-744-1231
Practice Address - Fax:804-744-9521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010303632080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty