Charles Bradford Jackson, MD

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

0101024618 Issued in VA

Practice address

2501 N Glebe Rd
Suite 201
Arlington, VA 22207-3558

Phone

(703) 525-1911

Fax

(866) 300-6035

NPI assigned

Apr 7, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323302400000",
    "number": "1447213996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 BLISS LN",
            "city": "GREAT FALLS",
            "state": "VA",
            "postal_code": "220663221",
            "telephone_number": "703-759-4109",
            "fax_number": "866-300-6031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 N GLEBE RD",
            "address_2": "SUITE 201",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222073558",
            "telephone_number": "703-525-1911",
            "fax_number": "866-300-6035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHARLES",
        "middle_name": "BRADFORD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-07",
        "last_updated": "2011-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "VA",
            "license": "0101024618",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "B/C 36190001",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6459871",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKSMANS COMP",
            "identifier": "148958700",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "CAREFIRST 3619001",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Imani Nadir Jabali-Vaughn, PTA
• Silsila Jabarkhail
• Jac Counseling PLLC
• Jenna Jach
• Araba Amonu Jackson, M.D.
• Faunice Rebecca Jackson, DPT, P.T.
• Irene Shetzline Jackson, M.A. CCCSLP
• Kaitlyn Jackson, DNAP, CRNA
• Takiya Nachelle Jackson, M.ED
• Terrina Jackson

• Sports Medicine (Orthopaedic Surgery) Physician in Arlington, VA
• Providers in Arlington, VA by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.