Healthcare Provider Details

I. General information

NPI: 1811925019
Provider Name (Legal Business Name): BRADLEY ALAN FORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3732 CARMAN RD
SCHENECTADY NY
12303-5422
US

IV. Provider business mailing address

711 TROY SCHENECTADY RD STE 203
LATHAM NY
12110-2461
US

V. Phone/Fax

Practice location:
  • Phone: 518-356-4132
  • Fax: 518-355-3996
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number138471
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: