Provider Demographics
NPI:1275529968
Name:BRADENHAM, BEN P (MD)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:P
Last Name:BRADENHAM
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 1:2369 STAPLES MILL RD
Mailing Address - Street 2:STE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2918
Mailing Address - Country:US
Mailing Address - Phone:804-285-4465
Mailing Address - Fax:804-285-8332
Practice Address - Street 1:7611 FOREST AVE
Practice Address - Street 2:STE 410
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4946
Practice Address - Country:US
Practice Address - Phone:804-285-2965
Practice Address - Fax:804-282-0616
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2011-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101029475207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006011420Medicaid
VA006011420Medicaid
B10208Medicare UPIN
VAA103398Medicare PIN