Individual
MR. SHAYNE D BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7505 OSLER DR, SUITE 506, TOWSON, MD 21204-7736
(410) 581-1600
Mailing address
25 CROSSROADS DR, SUITE 306, OWINGS MILLS, MD 21117-5421
(443) 738-2872
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
C0001923
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970005969
R/R MEDICARE PROVIDER #
MD
01
—
CN6601
R/R MEDICARE GROUP #
MD
Enumeration date
03/31/2006
Last updated
05/06/2014
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