Provider Demographics
NPI:1093974180
Name:BRADFORD MEDICAL GROUP
Entity Type:Organization
Organization Name:BRADFORD MEDICAL GROUP
Other - Org Name:DOROTHY MCELRATH BRADFORD, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-382-3750
Mailing Address - Street 1:5 SEVERANCE CIR
Mailing Address - Street 2:SUITE 815
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1566
Mailing Address - Country:US
Mailing Address - Phone:216-382-3750
Mailing Address - Fax:216-382-3122
Practice Address - Street 1:5 SEVERANCE CIR
Practice Address - Street 2:SUITE 815
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1566
Practice Address - Country:US
Practice Address - Phone:216-382-3750
Practice Address - Fax:216-382-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350083173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA17701Medicare UPIN
OH9276491Medicare PIN