MEDICARE: DR. ADRIANNA M BRAVO 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	208000000X	Pediatrics Physician	0101248208	VA
2	208000000X	Pediatrics Physician	C193520	CA
3	208000000X	Pediatrics Physician	041894	CT
4	208000000X	Pediatrics Physician	ME172870	FL

General Provider Information

NPI Number	:	1396939898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADRIANNA M BRAVO M.D.

Provider Business Mailing Address
First Line	:	1200 N QUAKER LN
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-3004
Country	:	US
Telephone Number	:	571-334-9591
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 N QUAKER LN
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-3004
Country	:	US
Telephone Number	:	571-334-9591
Fax Number	:

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

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	12/16/2025

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