Healthcare Provider Details

I. General information

NPI: 1497760979
Provider Name (Legal Business Name): BRADFORD S MCGWIRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 DODD DR FL 4
COLUMBUS OH
43210-1257
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-4854
  • Fax: 614-293-8102
Mailing address:
  • Phone: 614-293-2046
  • Fax: 614-366-2044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number35084862
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: