Provider Demographics
NPI:1558781120
Name:BRADBERRY, DAVID MARK JR (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARK
Last Name:BRADBERRY
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:311 SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:EAST SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02537-1370
Mailing Address - Country:US
Mailing Address - Phone:508-833-4160
Mailing Address - Fax:508-833-4202
Practice Address - Street 1:311 SERVICE RD
Practice Address - Street 2:
Practice Address - City:EAST SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02537-1370
Practice Address - Country:US
Practice Address - Phone:508-833-4160
Practice Address - Fax:508-833-4202
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN63446208100000X
MA290305208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation