Provider Demographics
NPI:1346294378
Name:KING, BRADFORD L (MD)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:L
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4548 EMPIRE CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-1939
Mailing Address - Country:US
Mailing Address - Phone:540-373-2244
Mailing Address - Fax:540-371-4849
Practice Address - Street 1:4548 EMPIRE CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-1939
Practice Address - Country:US
Practice Address - Phone:540-373-2244
Practice Address - Fax:540-371-4849
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101230572208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G19011Medicare UPIN