Provider Demographics
NPI:1073793501
Name:BRADLEY C ROBERTSON MD L L C
Entity Type:Organization
Organization Name:BRADLEY C ROBERTSON MD L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-836-7205
Mailing Address - Street 1:1 BARRINGTON PLACE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-5607
Mailing Address - Country:US
Mailing Address - Phone:410-836-7205
Mailing Address - Fax:410-836-7235
Practice Address - Street 1:1 BARRINGTON PLACE
Practice Address - Street 2:SUITE 106
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-5607
Practice Address - Country:US
Practice Address - Phone:410-836-7205
Practice Address - Fax:410-836-7235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00374092086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCK058 0001OtherCAREFIRST
MD1056903OtherUNITED HEALTHCARE
MD276BBCOtherCAREFIRST
GADC7136OtherRAILROAD MEDICARE
MD099NOtherMEDICARE
MD2432226OtherCIGNA
MD3115795OtherOPTIMUM CHOICE