Healthcare Provider Details

I. General information

NPI: 1245812700
Provider Name (Legal Business Name): COOPER BRADEN EHLERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2021
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S SHIRLINGTON RD FL 11
ARLINGTON VA
22206-3601
US

IV. Provider business mailing address

2800 S SHIRLINGTON RD FL 11
ARLINGTON VA
22206-3601
US

V. Phone/Fax

Practice location:
  • Phone: 703-892-6500
  • Fax:
Mailing address:
  • Phone: 703-892-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101289092
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: