Jackson, Charles Bradford

Jackson, Charles Bradford is an sole proprietor health care provider with primary practice located at 2501 N Glebe Rd Suite 201, Arlington VA 22207-3558. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Jackson, Charles Bradford can be contacted via phone (703) 525-1911.

Contact Information

Primary practice address
2501 N Glebe Rd Suite 201 Arlington VA 22207-3558
Phone: (703) 525-1911
Fax: (866) 300-6035
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X 0101024618 Virginia

Profile Details

NPI number 1447213996
LBN Legal business name Jackson, Charles Bradford
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 7th, 2006
Last updated Dec 8th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447213996 NPPES
Virginia Other B/C 36190001 BLUE CROSS
Virginia MEDICAID 6459871 BLUE CROSS
Virginia Other 148958700 BLUE CROSS
Virginia Other CAREFIRST 3619001 BLUE CROSS

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