Provider Demographics
NPI:1629185129
Name:ABRAHAMSON, BRADLEY SETH (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:SETH
Last Name:ABRAHAMSON
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 1:2020 S COLLEGE AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1464
Mailing Address - Country:US
Mailing Address - Phone:970-691-3847
Mailing Address - Fax:
Practice Address - Street 1:2020 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:970-488-1668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41009207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41009OtherSTATE LICENSE NUMBER
CO89100735Medicaid
COI49568Medicare UPIN
COC807140Medicare PIN