Basic Information
| Provider Information | |||||||||
| NPI: | 1982741872 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADSHAW | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | DANA | ||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235010936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465955 | ||||||||
| FaxNumber: | 7574465196 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 FAIRFAX AVE | ||||||||
| Address2: | HOFHEIMER HALL, SUITE 118 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235071914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465955 | ||||||||
| FaxNumber: | 7574465196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 01/30/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101244161 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 2083P0901X | 0101244161 | VA | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine |
ID Information
| ID | Type | State | Issuer | Description | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | 10086236 | 01 | VA | OPTIMA HEALTH | OTHER | 455290 | 01 | VA | ANTHEM BC/BS | OTHER | 1982741872 | 05 | NC | MEDICAID | PAR | 01 | VA | CORVEL | OTHER | 19827411872 | 01 | VA | VIRGINIA PREMIER HEALTH PLAN | OTHER | PAR | 01 | VA | AETNA | OTHER | -003 | 01 | VA | TRICARE/CHAMPUS | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | -002 | 01 | VA | TRICARE/CHAMPUS | OTHER | 1982741872 | 01 | VA | UNITED HEALTHCARE | OTHER | 1982741872 | 01 | VA | COVENTRY NATIONAL NETWORK/SOUTHERN HEALTH/FIRST HEALTH | OTHER | 1982741872 | 05 | VA | MEDICAID | PAR | 01 | VA | USA MANAGED CARE | OTHER |