Provider Demographics
NPI:1629046214
Name:BRADFIELD, BRUCE MAYNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MAYNARD
Last Name:BRADFIELD
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 1:158 CARNEGIE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2613
Mailing Address - Country:US
Mailing Address - Phone:757-272-2609
Mailing Address - Fax:
Practice Address - Street 1:158 CARNEGIE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2613
Practice Address - Country:US
Practice Address - Phone:757-272-2609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2254661Medicare ID - Type Unspecified
NCE64582Medicare UPIN