Provider Demographics
NPI:1912998782
Name:BRENDLINGER, JARROD MICHAEL (PA)
Entity Type:Individual
Prefix:
First Name:JARROD
Middle Name:MICHAEL
Last Name:BRENDLINGER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:1591 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3224
Practice Address - Country:US
Practice Address - Phone:610-326-8005
Practice Address - Fax:484-945-0572
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051143363AM0700X
PAOA000807363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P78001Medicare UPIN
PA066212Medicare ID - Type Unspecified