Individual
DR. CHARLES BRADFORD JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2501 N GLEBE RD, SUITE 201, ARLINGTON, VA 22207-3558
(703) 525-1911
(866) 300-6035
Mailing address
251 BLISS LN, GREAT FALLS, VA 22066-3221
(703) 759-4109
(866) 300-6031
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
0101024618
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
148958700
WORKSMANS COMP
VA
05
—
6459871
—
VA
01
—
B/C 36190001
BLUE CROSS
VA
01
—
CAREFIRST 3619001
CAREFIRST
VA
Enumeration date
04/07/2006
Last updated
12/08/2011
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