Provider Demographics
NPI:1336151109
Name:ROBERTSON, BRADLEY CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:CHARLES
Last Name:ROBERTSON
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 1:1 BARRINGTON PL
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-5607
Mailing Address - Country:US
Mailing Address - Phone:410-836-7205
Mailing Address - Fax:410-836-7235
Practice Address - Street 1:1 BARRINGTON PL
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-5607
Practice Address - Country:US
Practice Address - Phone:410-836-7205
Practice Address - Fax:410-836-7235
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00374092086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD52997412OtherCAREFIRST
MD45663365OtherAETNA
DCK058 0001OtherCAREFIRST
MD2432226OtherCIGNA
MD1056903OtherUNITED HEALTHCARE
MD3115795OtherOPTIMUM CHOICE
MD099N997FOtherMEDICARE
GAP00185846OtherRAILROAD MEDICARE