Provider Demographics
NPI:1720194194
Name:WARDEN, BRADFORD E (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:E
Last Name:WARDEN
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 1:2000 MON HEALTH MEDICAL PARK DR STE 2300
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1134
Mailing Address - Country:US
Mailing Address - Phone:304-599-8802
Mailing Address - Fax:304-599-5607
Practice Address - Street 1:2000 MON HEALTH MEDICAL PARK DR STE 2300
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1134
Practice Address - Country:US
Practice Address - Phone:304-599-8802
Practice Address - Fax:304-599-5607
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18828207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1805012000Medicaid
WV1805012000Medicaid
WV6031113Medicare PIN