MEDICARE: DR. BRIAN THOMAS BRADSHAW M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101042072	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033194774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN THOMAS BRADSHAW M.D.

Provider Business Mailing Address
First Line	:	2500 POCOSHOCK PL
Second Line	:	SUITE 103
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-6345
Country	:	US
Telephone Number	:	804-745-2200
Fax Number	:	804-745-9224

Provider Business Practice Location Address
First Line	:	2500 POCOSHOCK PL
Second Line	:	SUITE 103
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-6345
Country	:	US
Telephone Number	:	804-745-2200
Fax Number	:	804-745-9224

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	01/27/2022

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