Provider Demographics
NPI:1194731042
Name:MCCONNELL, BRENDAN MICHAEL (DPM)
Entity type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:MICHAEL
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 THIMBLE SHOALS BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4562
Mailing Address - Country:US
Mailing Address - Phone:757-873-1554
Mailing Address - Fax:757-873-3239
Practice Address - Street 1:4030 GEORGE WASHINGTON MEM HWY STE B
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-2619
Practice Address - Country:US
Practice Address - Phone:757-898-5500
Practice Address - Fax:757-898-8001
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000726213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1194731042OtherBLUE CROSS BLUE SHIELD
VA1194731042OtherUNITED HEALTHCARE
VA480006732OtherRAILROAD MEDICARE
VA009300104Medicaid
VA1194731042OtherOPTIMA
VA1194731042OtherMULTIPLAN
VA1194731042OtherTRICARE
VA1194731042OtherCIGNA
VA1194731042OtherVIRGINIA HEALTH NETWORK
VA1194731042OtherHUMANA
VA1194731042OtherPHCS
VA1194731042OtherMAMSI
VA4122283OtherAETNA
VA4122283OtherAETNA