Provider Demographics
NPI:1619189404
Name:MANNING, BRADLEY BOWKER (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:BOWKER
Last Name:MANNING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRAD
Other - Middle Name:BOWKER
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:887B RIO EAST CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8004
Mailing Address - Country:US
Mailing Address - Phone:434-220-4686
Mailing Address - Fax:434-220-4687
Practice Address - Street 1:887B RIO EAST CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8004
Practice Address - Country:US
Practice Address - Phone:434-220-4686
Practice Address - Fax:434-220-4687
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012416402084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry