Provider Demographics
NPI:1093791964
Name:BRADFORD, JOHN ADDITON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ADDITON
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-5035
Mailing Address - Fax:207-973-5042
Practice Address - Street 1:925 UNION ST STE 3
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3051
Practice Address - Country:US
Practice Address - Phone:207-973-9980
Practice Address - Fax:207-973-7515
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011526174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MED03693OtherHARVARD PILGRIM
MEM57740OtherCIGNA
ME1044474OtherAETNA
ME002921OtherBLUES
ME100289800OtherUS DEPT OF LABOR
ME116170000Medicaid
ME200002275OtherMEDICARE RAILROAD
ME100289800OtherUS DEPT OF LABOR
ME200002275OtherMEDICARE RAILROAD