Individual
DR. BRADFORD CLARK DICKERSON
Active
Individual
DR. BRADFORD CLARK DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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