Provider Demographics
NPI:1255332169
Name:HALL, BRADFORD S (MD)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:S
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:248 PLEASANT ST
Mailing Address - Street 2:STE 1600
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2588
Mailing Address - Country:US
Mailing Address - Phone:603-224-2020
Mailing Address - Fax:603-228-0248
Practice Address - Street 1:248 PLEASANT ST
Practice Address - Street 2:STE 1600
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2588
Practice Address - Country:US
Practice Address - Phone:603-224-2020
Practice Address - Fax:603-228-0248
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH10842207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30200832Medicaid
180039111OtherMEDICARE RR
7177308OtherAETNA
NH01Y002354NH01OtherANTHEM
NH330441OtherCIGNA
7177308OtherAETNA
180039111OtherMEDICARE RR