Provider Demographics
NPI:1508817834
Name:SCHAFFER, BRADLEY K (MD)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:K
Last Name:SCHAFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 SUMMER ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-3609
Mailing Address - Country:US
Mailing Address - Phone:508-363-6363
Mailing Address - Fax:508-363-6366
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 520
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-3609
Practice Address - Country:US
Practice Address - Phone:508-363-6363
Practice Address - Fax:508-363-6366
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160955174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0156019Medicaid
MAH43651Medicare UPIN
MAA32088Medicare ID - Type UnspecifiedMASS MEDICARE NUMBER