Provider Demographics
NPI:1588045975
Name:WOODMAN, BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:WOODMAN
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 1:2435 W. BELVEDERE AVENUE
Mailing Address - Street 2:HOFFBERGER BUILDING, SUITE 56
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215
Mailing Address - Country:US
Mailing Address - Phone:410-601-0594
Mailing Address - Fax:410-601-0939
Practice Address - Street 1:2435 W. BELVEDERE AVENUE
Practice Address - Street 2:HOFFBERGER BUILDING, SUITE 56
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-601-0594
Practice Address - Fax:410-601-0939
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD87034207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program