Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 242806 | MA |
Y | 207VX0201X | Gynecologic Oncologist | 242806 | MA |
NPI | 1124063441 |
---|---|
Provider Name | Leslie S Bradford |
First Address | Boston, MA 02241-5348 |
Second Address | Scarborough, ME 04074-7171 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 18/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110085476A | (05) | MA |
E400422717 | MEDICARE (01) | ME |
E400422720 | MEDICARE (01) | ME |