Provider Demographics
NPI:1588641435
Name:BRADFORD, PAUL D (PA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34TH ST. AND CIVIC CENTER BLVD.
Mailing Address - Street 2:CHOP: PEDIATRIC ORTHOPAEDIC SURGERY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-590-1527
Mailing Address - Fax:215-590-1501
Practice Address - Street 1:34TH ST. AND CIVIC CENTER BLVD.
Practice Address - Street 2:CHOP: PEDIATRIC ORTHOPAEDIC SURGERY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-590-1527
Practice Address - Fax:215-590-1501
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052143363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
093892Medicare ID - Type Unspecified
Q50394Medicare UPIN