Provider Demographics
NPI:1588854277
Name:GLADFELTER, BAMBI (DO)
Entity Type:Individual
Prefix:DR
First Name:BAMBI
Middle Name:
Last Name:GLADFELTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 FOREST AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1726
Mailing Address - Country:US
Mailing Address - Phone:804-420-1205
Mailing Address - Fax:804-420-1201
Practice Address - Street 1:7001 FOREST AVE STE 302
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1726
Practice Address - Country:US
Practice Address - Phone:804-420-1205
Practice Address - Fax:804-420-1201
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-28
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116019630207Q00000X
VA0102202372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine