Provider Demographics
NPI:1851693659
Name:MARTIN, BRADLEY EUGENE (CAPS)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:EUGENE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8414 MEADOW GREEN WAY
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3741
Mailing Address - Country:US
Mailing Address - Phone:540-476-4503
Mailing Address - Fax:301-330-1306
Practice Address - Street 1:8414 MEADOW GREEN WAY
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-3741
Practice Address - Country:US
Practice Address - Phone:540-476-4503
Practice Address - Fax:301-330-1306
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101960171WH0202X
VA2705137380171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications