MEDICARE: DONALD J BRIDEAU JR. 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	207Q00000X	Family Medicine Physician	0101047491	VA

General Provider Information

NPI Number	:	1891807269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD J BRIDEAU JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 37189
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21297-3189
Country	:	US
Telephone Number	:	571-423-5699
Fax Number	:	571-423-5698

Provider Business Practice Location Address
First Line	:	6355 WALKER LN STE 500
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-3251
Country	:	US
Telephone Number	:	703-971-8600
Fax Number	:	703-971-9043

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	02/02/2021

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