Provider Demographics
NPI:1629095666
Name:BRADFORD, PAMELA FOX (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:FOX
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4218
Practice Address - Street 1:601 E MAIN ST LEVEL 3
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-2332
Practice Address - Country:US
Practice Address - Phone:717-765-5087
Practice Address - Fax:717-765-5070
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038892207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103054035Medicaid
MD425475-01OtherBS OF MD
DC0004 F288OtherBS OF DC
MD110036965OtherRR MEDICARE
MD546271500Medicaid
1629095666OtherNPI