Provider Demographics
NPI:1922267970
Name:DEAFENBAUGH, BRADLEY KEITH (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:KEITH
Last Name:DEAFENBAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:620 JOHN PAUL JONES CIR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708-2111
Mailing Address - Country:US
Mailing Address - Phone:757-953-0815
Mailing Address - Fax:757-953-1269
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-1813
Practice Address - Fax:916-703-5074
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2022-07-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA130245207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma