Provider Demographics
NPI:1831183128
Name:BRADLEY, JOAN D (MD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:D
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:T
Other - Last Name:DOERFLINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:115 PARK ST SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4653
Mailing Address - Country:US
Mailing Address - Phone:703-255-9100
Mailing Address - Fax:703-255-3457
Practice Address - Street 1:115 PARK ST SE
Practice Address - Street 2:SUITE 300
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4653
Practice Address - Country:US
Practice Address - Phone:703-255-9100
Practice Address - Fax:703-255-3457
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054346207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G44451Medicare UPIN
VA00A425F82Medicare ID - Type Unspecified