Basic Information
| Provider Information | |||||||||
| NPI: | 1952376907 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEDZIAN | ||||||||
| FirstName: | BRADFORD | ||||||||
| MiddleName: | GREGORY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2415 N ORANGE AVE STE 700 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328045521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073032474 | ||||||||
| FaxNumber: | 4073030680 | ||||||||
| Practice Location | |||||||||
| Address1: | 2415 N ORANGE AVE STE 700 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328045521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073032474 | ||||||||
| FaxNumber: | 4073030680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 10/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 001228 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 25MP00085600 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | PA9107190 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | HI023Z | 01 | FL | PTAN | OTHER |