Healthcare Provider Details

I. General information

NPI: 1124063441
Provider Name (Legal Business Name): LESLIE SIRIYA BRADFORD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMPUS DR STE 125
SCARBOROUGH ME
04074-7171
US

IV. Provider business mailing address

100 CAMPUS DR UNIT 125
SCARBOROUGH ME
04074-7171
US

V. Phone/Fax

Practice location:
  • Phone: 207-883-0069
  • Fax:
Mailing address:
  • Phone: 207-883-0069
  • Fax: 207-883-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD21679
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number242806
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number242806
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD21679
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: