Provider Demographics
NPI:1598871162
Name:TUCKER, BRADFORD SCHOFIELD (MD)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:SCHOFIELD
Last Name:TUCKER
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 1:833 CHESTNUT ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4430
Mailing Address - Country:US
Mailing Address - Phone:800-321-9999
Mailing Address - Fax:267-339-3761
Practice Address - Street 1:2500 ENGLISH CREEK AVE
Practice Address - Street 2:BUILDING 1300
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5549
Practice Address - Country:US
Practice Address - Phone:609-677-6060
Practice Address - Fax:609-677-6061
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432593207XX0005X
NJ25MA06863800207X00000X, 207XX0005X
FLME153072207XX0005X
NY303724207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2220116000OtherIBC
NJ054146PFCMedicare PIN
H54054Medicare UPIN
NJ2220116000OtherIBC