Healthcare Provider Details

I. General information

NPI: 1982966552
Provider Name (Legal Business Name): BRITNI BRADSHAW MAPLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITNI MARIE BRADSHAW M.D.

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GROVE ROAD BRYAN NEONATAL INTENSIVE CARE UNIT
GREENVILLE SC
29605
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-608-0296
  • Fax:
Mailing address:
  • Phone: 864-522-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34859
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number34859
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: