Provider Demographics
NPI:1790133999
Name:BIRTH, BRADLEY JONATHAN (DO)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JONATHAN
Last Name:BIRTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:BRAD
Other - Middle Name:JONATHAN
Other - Last Name:BIRTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:104 SELMA DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3834
Mailing Address - Country:US
Mailing Address - Phone:540-678-2853
Mailing Address - Fax:540-678-2859
Practice Address - Street 1:104 SELMA DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3834
Practice Address - Country:US
Practice Address - Phone:540-678-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102205242207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine