Provider Demographics
NPI:1518920867
Name:BRADNER, JAMES ELLIOTT (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ELLIOTT
Last Name:BRADNER
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 1:129 FRANKLIN ST
Mailing Address - Street 2:#317
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139
Mailing Address - Country:US
Mailing Address - Phone:617-549-4786
Mailing Address - Fax:617-632-5168
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:DANA-FARBER CANCER INSTITUTE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-6629
Practice Address - Fax:617-632-5168
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA216495207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
9397595OtherCIGNA
MAJ28334OtherBCBS INDEMITY BC ELECT HM
464288OtherTUFTS
MA2076560Medicaid
A37557Medicare ID - Type UnspecifiedMEDICARE
MA2076560Medicaid