Individual
MR. MARK BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1 TEXAS STATION CT, TIMONIUM, MD 21093-8286
(410) 683-2120
(410) 683-2130
Mailing address
2200 KERNAN DR, 1ST FLOOR ORTHOPAEDICS SUITE, BALTIMORE, MD 21207-6665
(410) 448-6375
(410) 448-6296
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
C0003213
MD
363AM0700X
Medical Physician Assistant
Primary
C0003213
MD
363AS0400X
Surgical Physician Assistant
COOO3213
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1831137611
NPI
MD
01
—
665L
MEDICARE GROUP UMOA
MD
Enumeration date
06/03/2006
Last updated
02/17/2015
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