Provider Demographics
NPI:1417910746
Name:WARE, BRADLEY RICHARD (MD)
Entity Type:Individual
Prefix:PROF
First Name:BRADLEY
Middle Name:RICHARD
Last Name:WARE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5249 DUKE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2926
Mailing Address - Country:US
Mailing Address - Phone:703-823-3660
Mailing Address - Fax:703-823-2210
Practice Address - Street 1:5249 DUKE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2926
Practice Address - Country:US
Practice Address - Phone:703-823-3660
Practice Address - Fax:703-823-2210
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101050807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC72887Medicare UPIN