Provider Demographics
NPI:1881792570
Name:BRADSHER, ANN TORIAN (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:TORIAN
Last Name:BRADSHER
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 1:1550 FAULK ST
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-6304
Mailing Address - Country:US
Mailing Address - Phone:704-283-1990
Mailing Address - Fax:704-289-5299
Practice Address - Street 1:1550 FAULK ST
Practice Address - Street 2:SUITE 3100
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-6304
Practice Address - Country:US
Practice Address - Phone:704-283-1990
Practice Address - Fax:704-289-5299
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201435207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913297Medicaid
SCNC1080Medicaid
NC13297OtherBCBS NC
NC8913297Medicaid
NC2008343Medicare PIN
NC2008343CMedicare PIN