Individual
DR. BRADFORD CLARK DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15 PARKMAN ST, WACC 835, BOSTON, MA 02114-3117
(617) 726-1728
Mailing address
149 13TH ST, SUITE 2691, CHARLESTOWN, MA 02129-2020
(617) 724-6557
(617) 726-5760
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
216084
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2018811
—
MA
01
—
216084
TUFTS HEALTH PLAN
MA
01
—
J26662
BCBS MA
MA
Enumeration date
11/02/2005
Last updated
11/06/2012
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