Provider Demographics
NPI:1497845234
Name:SELLAND, BRADFORD ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:ALAN
Last Name:SELLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BRAD
Other - Middle Name:
Other - Last Name:SELLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:3000 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6132
Practice Address - Country:US
Practice Address - Phone:701-364-8000
Practice Address - Fax:701-364-8078
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47736174400000X
ND4404207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN713336Medicaid
MA0138827Medicaid
MAA66501Medicare UPIN
MAE05514Medicare ID - Type Unspecified
ND14611Medicare PIN