Individual
MR. CHARLES JEREMY BRADSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPAS PA-C
Contact information
Practice address
5716 CLEVELAND ST STE 200, VIRGINIA BEACH, VA 23462-1784
(757) 490-4802
Mailing address
5716 CLEVELAND ST STE 200, VIRGINIA BEACH, VA 23462-1784
(757) 490-4802
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110003574
VA
363A00000X
Physician Assistant
1081007
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VAD000
TRICARE
—
Enumeration date
05/21/2008
Last updated
02/18/2026
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