Healthcare Provider Details

I. General information

NPI: 1225097298
Provider Name (Legal Business Name): BRADFORD S PONTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 ARLINGTON BLVD SUITE 310
FAIRFAX VA
22031-5207
US

IV. Provider business mailing address

8316 ARLINGTON BLVD SUITE 310
FAIRFAX VA
22031-5207
US

V. Phone/Fax

Practice location:
  • Phone: 703-641-0333
  • Fax: 703-573-3316
Mailing address:
  • Phone: 703-641-0333
  • Fax: 703-573-3316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101055063
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: