Healthcare Provider Details

I. General information

NPI: 1851350326
Provider Name (Legal Business Name): DANIEL WILLIAM BRADFORD MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 FULTON ST DURHAM VAMC
DURHAM NC
27705-3875
US

IV. Provider business mailing address

508 FULTON ST DURHAM VAMC
DURHAM NC
27705-3875
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-0411
  • Fax: 919-869-1343
Mailing address:
  • Phone: 919-286-0411
  • Fax: 919-869-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number0101264177
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number200100312
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101264177
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: