Provider Demographics
NPI:1891807269
Name:BRIDEAU, DONALD J JR (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:BRIDEAU
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 37189
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3189
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:6355 WALKER LN STE 500
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3251
Practice Address - Country:US
Practice Address - Phone:703-971-8600
Practice Address - Fax:703-971-9043
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101047491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A351S21Medicare ID - Type Unspecified
F33273Medicare UPIN