Provider Demographics
NPI:1043897705
Name:POWERS, BRADLEY JACOB (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JACOB
Last Name:POWERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 W ST NW APT 322
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-6847
Mailing Address - Country:US
Mailing Address - Phone:504-432-9651
Mailing Address - Fax:
Practice Address - Street 1:2800 S SHIRLINGTON RD STE 500
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-3618
Practice Address - Country:US
Practice Address - Phone:703-717-4245
Practice Address - Fax:703-717-4248
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101280787207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine