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JOHN ANDREW BRADSHAW

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
10 GRAHAM RD W, ITHACA, NY 14850-1055
(607) 257-2188
(607) 266-7341
Mailing address
10 GRAHAM RD W, ITHACA, NY 14850-1055
(607) 257-2188
(607) 266-7341

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
216716
NY
2080P0208X
Pediatric Infectious Diseases Physician
216716
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000136319
BLUE SHIELD/HMO/EXCELLUS
01
00920290002
HEALTH NOW
05
02223650
NY
01
10867
TOTALCARE/MANAGED MA
NY
01
161010811
RMSCO
01
V018315
TRICARE
Enumeration date
11/19/2005
Last updated
09/21/2012
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