Organization
BRADLEE FAMILY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LESLIE GEORGE GONDOR MD (OWNER/PRESIDENT)
(703) 379-6020
Entity
Organization
Contact information
Practice address
3541 W BRADDOCK RD, 101, ALEXANDRIA, VA 22302-1915
(703) 379-6020
(703) 820-8799
Mailing address
3541 W BRADDOCK RD, SUITE 101, ALEXANDRIA, VA 22302-1915
(703) 379-6020
(703) 820-8799
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
101223709
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
172715
ANTHEM HEALTHKEEPERS
—
01
—
2466957
UNITED HEALTH CARE
—
01
—
283569
INTOTAL
VA
01
—
3681092
AETNA HMO
—
01
—
4718781
CIGNA
—
05
—
5613060
—
VA
01
—
7782527
AETNA PPO
—
01
—
K2040001
BCBS
DC
Enumeration date
04/03/2014
Last updated
04/03/2014
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