Provider Demographics
NPI:1710989744
Name:BRADBURY, WILLIAM M (MD,FACC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:BRADBURY
Suffix:
Gender:M
Credentials:MD,FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 KENNEDY DR STE A
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1946
Mailing Address - Country:US
Mailing Address - Phone:860-963-7519
Mailing Address - Fax:860-963-0668
Practice Address - Street 1:37 KENNEDY DR STE A
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1946
Practice Address - Country:US
Practice Address - Phone:860-963-7519
Practice Address - Fax:860-963-0668
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029771207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001297713Medicaid
CTCM3360Medicare PIN
CT060000975Medicare PIN