Provider Demographics
NPI:1851350326
Name:BRADFORD, DANIEL WILLIAM (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WILLIAM
Last Name:BRADFORD
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Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:508 FULTON ST
Mailing Address - Street 2:DURHAM VAMC
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3875
Mailing Address - Country:US
Mailing Address - Phone:919-286-0411
Mailing Address - Fax:919-869-1343
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:DURHAM VAMC
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-0411
Practice Address - Fax:919-869-1343
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012641772084A0401X, 2084P0800X
NC2001003122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH49491Medicare UPIN