Provider Demographics
NPI:1407923931
Name:ZUCKERMAN, BRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BRAM
Middle Name:
Last Name:ZUCKERMAN
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 1:8377 GREENSBORO DR # A
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3529
Mailing Address - Country:US
Mailing Address - Phone:703-442-0617
Mailing Address - Fax:
Practice Address - Street 1:8377 GREENSBORO DR # A
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3529
Practice Address - Country:US
Practice Address - Phone:703-442-0617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043401174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0000708161Medicare ID - Type Unspecified
VAF15162Medicare UPIN