Provider Demographics
NPI:1841495330
Name:LEYPOLD, BRADLEY GEORGES (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:GEORGES
Last Name:LEYPOLD
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-4240
Mailing Address - Country:US
Mailing Address - Phone:203-264-7999
Mailing Address - Fax:203-264-7477
Practice Address - Street 1:385 MAIN ST. SOUTH
Practice Address - Street 2:C/O NVRA UNION SQUARE BLDG #1
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488
Practice Address - Country:US
Practice Address - Phone:203-264-7999
Practice Address - Fax:203-264-7477
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0465622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400000261Medicare PIN
CTD400000267Medicare PIN
CTD400000266Medicare PIN
CTD400000264Medicare PIN
D400000265Medicare PIN
CTD400000262Medicare PIN
CTD400000263Medicare PIN