Provider Demographics
NPI:1982741872
Name:BRADSHAW, ROBERT DANA (MD, MPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DANA
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5955
Mailing Address - Fax:757-446-5196
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:HOFHEIMER HALL, SUITE 118
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5955
Practice Address - Fax:757-446-5196
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244161207Q00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherVIRGINIA HEALTH NETWORK
VA10086236OtherOPTIMA HEALTH
VA455290OtherANTHEM BC/BS
NC1982741872Medicaid
VAPAROtherCORVEL
VA19827411872OtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherAETNA
VA-003OtherTRICARE/CHAMPUS
VAPAROtherMULTIPLAN
VA-002OtherTRICARE/CHAMPUS
VA1982741872OtherUNITED HEALTHCARE
VA1982741872OtherCOVENTRY NATIONAL NETWORK/SOUTHERN HEALTH/FIRST HEALTH
VA1982741872Medicaid
VAPAROtherUSA MANAGED CARE
VAPAROtherMULTIPLAN
VA1982741872Medicaid