Basic Information
| Provider Information | |||||||||
| NPI: | 1558781120 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADBERRY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 311 SERVICE RD | ||||||||
| Address2: | |||||||||
| City: | EAST SANDWICH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025371370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088334160 | ||||||||
| FaxNumber: | 5088334202 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 SERVICE RD | ||||||||
| Address2: | |||||||||
| City: | EAST SANDWICH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025371370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088334160 | ||||||||
| FaxNumber: | 5088334202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2014 | ||||||||
| LastUpdateDate: | 11/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 63446 | MN | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 290305 | MA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.