Provider Demographics
NPI:1689886509
Name:SHARP, BRADLEY ALLEN (HMC SF-IDC)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:ALLEN
Last Name:SHARP
Suffix:
Gender:M
Credentials:HMC SF-IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 WILDERNESS RD
Mailing Address - Street 2:NAVCON BRIG CHESAPEAKE
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-4513
Mailing Address - Country:US
Mailing Address - Phone:757-421-8639
Mailing Address - Fax:
Practice Address - Street 1:1548 WILDERNESS RD
Practice Address - Street 2:NAVCON BRIG CHESAPEAKE
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-4513
Practice Address - Country:US
Practice Address - Phone:757-421-8639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman