Provider Demographics
NPI:1124070602
Name:FLYNN, BRENDAN MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:MICHAEL
Last Name:FLYNN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W CORK ST UNIT 405
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3876
Mailing Address - Country:US
Mailing Address - Phone:540-313-9200
Mailing Address - Fax:
Practice Address - Street 1:333 W CORK ST UNIT 405
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3876
Practice Address - Country:US
Practice Address - Phone:540-313-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47185207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68773331Medicaid
CO303459Medicare PIN