Healthcare Provider Details

I. General information

NPI: 1639708522
Provider Name (Legal Business Name): BRADLEY HOBART CLEMENS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 GREENBRIER CIR STE A
CHESAPEAKE VA
23320-3338
US

IV. Provider business mailing address

816 GREENBRIER CIR STE A
CHESAPEAKE VA
23320-3338
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-3400
  • Fax: 757-461-7130
Mailing address:
  • Phone: 757-461-3400
  • Fax: 757-461-7130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5151014362
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116037531
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number0102209328
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: