Healthcare Provider Details

I. General information

NPI: 1093974180
Provider Name (Legal Business Name): BRADFORD MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 08/05/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29001 CEDAR RD #429
LYNDHURST OH
44124
US

IV. Provider business mailing address

29001 CEDAR RD #429
LYNDHURST OH
44124
US

V. Phone/Fax

Practice location:
  • Phone: 440-565-7173
  • Fax: 440-565-7183
Mailing address:
  • Phone: 440-565-7173
  • Fax: 440-565-7183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number350083
License Number StateOH

VIII. Authorized Official

Name: DR. DOROTHY ANN BRADFORD
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 440-565-7173