Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 2002012320 | MO |
Y | 207VX0201X | Gynecologic Oncologist | 055981 | CT |
N | 207VX0201X | Gynecologic Oncologist | 2002012320 | MO |
NPI | 1518949270 |
---|---|
Provider Name | Dr. Bradford P. Whitcomb |
First Address | Farmington, CT 06030-0001 |
Second Address | Farmington, CT 06030-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 20/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) |