Provider Demographics
NPI:1114900909
Name:RADFORD, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:RADFORD
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 1:25 BRAUNVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2045
Mailing Address - Country:US
Mailing Address - Phone:716-662-3876
Mailing Address - Fax:
Practice Address - Street 1:ERPG EMERGENCY SERVICES
Practice Address - Street 2:763 JOHNSONBURG ROAD
Practice Address - City:ST. MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857
Practice Address - Country:US
Practice Address - Phone:814-788-8595
Practice Address - Fax:814-788-8036
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427757207P00000X
NY215230207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH15651Medicare UPIN