Provider Demographics
NPI:1649288580
Name:BRADSHAW, ERICA LOUISE (MD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:LOUISE
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:780 LYNNHAVEN PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7332
Mailing Address - Country:US
Mailing Address - Phone:757-468-0550
Mailing Address - Fax:757-468-9992
Practice Address - Street 1:780 LYNNHAVEN PKWY
Practice Address - Street 2:SUITE 400 ATLANTIC PSYCHIATRIC SERVICES
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7332
Practice Address - Country:US
Practice Address - Phone:757-468-0550
Practice Address - Fax:757-468-9992
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010476352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA089535MOtherSENATRA
228018OtherCIGNA
197580OtherAETNA
228018OtherCIGNA