Provider Demographics
NPI:1225097165
Name:BRADFORD, MASHELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:MASHELLE
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MASHELLE
Other - Middle Name:EVOLA
Other - Last Name:BRADFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16526 NC HIGHWAY 87 W
Mailing Address - Street 2:
Mailing Address - City:TAR HEEL
Mailing Address - State:NC
Mailing Address - Zip Code:28392-8608
Mailing Address - Country:US
Mailing Address - Phone:919-210-4365
Mailing Address - Fax:
Practice Address - Street 1:16526 NC HIGHWAY 87 W
Practice Address - Street 2:
Practice Address - City:TAR HEEL
Practice Address - State:NC
Practice Address - Zip Code:28392-8608
Practice Address - Country:US
Practice Address - Phone:919-753-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG64429Medicare UPIN
2400659AMedicare ID - Type Unspecified