Basic Information
Provider Information | |||||||||
NPI: | 1518952555 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BRADFORD | ||||||||
FirstName: | NORMAN | ||||||||
MiddleName: | F. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 785 5TH AVENUE | ||||||||
Address2: | SUITE 3 | ||||||||
City: | CHAMBERSBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 172014232 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7172639555 | ||||||||
FaxNumber: | 7172174217 | ||||||||
Practice Location | |||||||||
Address1: | 112 N. SEVENTH STREET | ||||||||
Address2: |   | ||||||||
City: | CHAMBERSBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 17201 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7172677164 | ||||||||
FaxNumber: | 7172677414 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/15/2005 | ||||||||
LastUpdateDate: | 10/23/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | D38813 | MD | N |   | Allopathic & Osteopathic Physicians | Anesthesiology |   | 207L00000X | MD038978E | PA | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | 25-1716306 | 01 | PA | FIRST HEALTH | OTHER | 5969102 | 01 | PA | AETNA NON-HMO | OTHER | MD038978E | 01 | PA | MEDICAL LICENSE | OTHER | 25-1716306 | 01 | PA | INTERGROUP | OTHER | 273307 | 01 | PA | UNISON | OTHER | FB1390400 | 01 | PA | DEA | OTHER | 120420418 | 01 | PA | DEPT OF LABOR | OTHER | 25-1716306 | 01 | PA | SOUTH CENTRAL | OTHER | 6906113 | 01 | PA | AETNA HMO | OTHER | G920-0122/85XWCU | 01 | PA | CAREFIRST | OTHER | 1717223 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 25-1716306 | 01 | PA | MULTIPLAN/PHCS | OTHER | 1583301 | 01 | PA | GATEWAY | OTHER | 2183091 | 01 | PA | MAMSI | OTHER | 25-1716306 | 01 | PA | INFORMED | OTHER | 001522547 0006 | 05 | PA |   | MEDICAID | P00741672 | 01 | PA | RAILROAD MEDICARE | OTHER | 251716306 | 01 | PA | HEALTH NET | OTHER | 50085998 | 01 | PA | CAPITAL BLUECROSS | OTHER | 050514 | 01 | PA | GROUP MEDICARE # | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | PEARL | 01 | PA | HEALTH AMERICA | OTHER |