Healthcare Provider Details

I. General information

NPI: 1548757834
Provider Name (Legal Business Name): MICHAEL BRANTLEY ADAMS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0004
US

IV. Provider business mailing address

SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-ZDM-M 3551 ROGER BROOKE DR.
JBSA-FORT SAM HOUSTON TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4600
  • Fax:
Mailing address:
  • Phone: 210-916-5910
  • Fax: 210-916-2077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0102205934
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102205934
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: