Provider Demographics
NPI:1588691638
Name:KOMROWSKI-POPPEN, BRADLEY JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JOSEPH
Last Name:KOMROWSKI-POPPEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:BRADLEY
Other - Middle Name:JK
Other - Last Name:POPPEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2817 REILLY ROAD
Mailing Address - Street 2:MCXC-COD CREDENTIALS WOMACK ARMY MEDICAL CENTER
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310
Mailing Address - Country:US
Mailing Address - Phone:910-907-8922
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:2817 REILLY ROAD DOBH
Practice Address - Street 2:WOMACK AMC
Practice Address - City:FT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310
Practice Address - Country:US
Practice Address - Phone:910-907-6825
Practice Address - Fax:910-907-8521
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL985103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist