Individual
MR. BRADLEY KEVIN GORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9430 FORESTWOOD LANE, SUITE 100, MANASSAS, VA 20110
(703) 365-0227
(703) 365-0332
Mailing address
9430 FORESTWOOD LANE, SUITE 100, MANASSAS, VA 20110
(703) 365-0227
(703) 365-0332
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0101246204
VA
208000000X
Pediatrics Physician
Primary
26427
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265491526
—
VA
Enumeration date
03/23/2006
Last updated
12/14/2009
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