| Organization Name: | BRADLEE FAMILY HEALTH CENTER |
| NPI Number: | 1013335371 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LESLIE GEORGE GONDOR (OWNER/PRESIDENT) |
| Mailing Address: | 3541 W Braddock Rd 101 Alexandria |
| State: | VA US |
| Postal Code: | 223021915 |
| Phone Number: | 7033796020 |
| Fax Number: | 7038208799 |
| NPI Enumeration Date: | 04/03/2014 |
| NPI Last Update Date: | 04/03/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 101223709 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |