Provider Demographics
NPI:1639311707
Name:BRADFORD, SUSAN EMILY (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:EMILY
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HUDSON AVE
Mailing Address - Street 2:PO BOX 144
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4313
Mailing Address - Country:US
Mailing Address - Phone:518-793-4477
Mailing Address - Fax:
Practice Address - Street 1:6 CARPENTER LN
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5521
Practice Address - Country:US
Practice Address - Phone:518-583-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267468207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology