Provider Demographics
NPI:1740273143
Name:YOUNG, BRADFORD (MD)
Entity type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2741 NAVARRE AVE
Mailing Address - Street 2:STE 401
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3278
Mailing Address - Country:US
Mailing Address - Phone:419-693-7071
Mailing Address - Fax:419-693-3051
Practice Address - Street 1:2741 NAVARRE AVE
Practice Address - Street 2:STE 401
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3278
Practice Address - Country:US
Practice Address - Phone:419-693-7071
Practice Address - Fax:419-693-3051
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2010-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35071273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC47030Medicare UPIN