Healthcare Provider Details

I. General information

NPI: 1073876686
Provider Name (Legal Business Name): ANDREW J. BRADLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-2323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD84785
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD042974
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: