Healthcare Provider Details

I. General information

NPI: 1609808773
Provider Name (Legal Business Name): VESTINIA MADONNA BRIDGES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VESTINIA MADONNA POLK M.D.

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8926 WOODYARD ROAD SUITE 701
CLINTON MD
20735
US

IV. Provider business mailing address

8926 WOODYARD ROAD SUITE 701
CLINTON MD
20735
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-1682
  • Fax: 301-856-0964
Mailing address:
  • Phone: 301-856-1682
  • Fax: 301-856-0964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0052474
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101231874
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD30799
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number0101231874
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberD0052474
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: