Provider Demographics
NPI:1033382049
Name:SWELSTAD, BRAD B (MD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:B
Last Name:SWELSTAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 BLACKWELL RD STE 500
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3783
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13580 GROUPE DR STE 105
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4163
Practice Address - Country:US
Practice Address - Phone:703-680-1770
Practice Address - Fax:855-402-1839
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60680871207V00000X
VA0101265847207VE0102X
MDD0066846207VE0102X, 207VE0102X
TXN0491207VE0102X
CAA116519207VE0102X
IDM-11517207VE0102X
UT8077141-1205207VE0102X
CODR-50814207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD018471300Medicaid