Provider Demographics
NPI:1043897705
Name:POWERS, BRADLEY JACOB
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JACOB
Last Name:POWERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 RESERVOIR ROAD NW
Mailing Address - Street 2:DEPT OF MEDICINE
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007
Mailing Address - Country:US
Mailing Address - Phone:202-444-8168
Mailing Address - Fax:877-303-1460
Practice Address - Street 1:3800 RESERVOIR ROAD NW
Practice Address - Street 2:DEPT OF MEDICINE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007
Practice Address - Country:US
Practice Address - Phone:202-444-8168
Practice Address - Fax:877-303-1460
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program