Healthcare Provider Details

I. General information

NPI: 1033040126
Provider Name (Legal Business Name): AMALIA BRADBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 OLD GEORGETOWN RD STE 301
BETHESDA MD
20814-6133
US

IV. Provider business mailing address

7500 OLD GEORGETOWN RD STE 301
BETHESDA MD
20814-6133
US

V. Phone/Fax

Practice location:
  • Phone: 301-657-9876
  • Fax: 301-657-8240
Mailing address:
  • Phone: 301-657-9876
  • Fax: 301-657-8240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: