Basic Information
| Provider Information | |||||||||
| NPI: | 1134384720 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYD | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3620 JOSPEH SIEWICK DR STE 201 | ||||||||
| Address2: | FAIR OAKS ORTHOPAEDIC ASSOCIATES | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033910111 | ||||||||
| FaxNumber: | 7033912945 | ||||||||
| Practice Location | |||||||||
| Address1: | 3620 JOSPEH SIEWICK DR STE 201 | ||||||||
| Address2: | FAIR OAKS ORTHOPAEDIC ASSOCIATES | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033910111 | ||||||||
| FaxNumber: | 7033912945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2008 | ||||||||
| LastUpdateDate: | 12/03/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 0102203371 | VA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.