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General NPI Number Information
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NPI Number | 1124063441
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Entity Type | Individual
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Provider Name | LESLIE SIRIYA BRADFORD MD
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Gender | Female
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 100 CAMPUS DR STE 125
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City | SCARBOROUGH
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State | ME
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Zip | 04074-7171
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Country | US
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Telephone | 207-883-0069
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Fax |
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Provider Business Mailing Address
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Address Line | 100 CAMPUS DR UNIT 125
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City | SCARBOROUGH
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State | ME
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Zip | 04074-7171
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Country | US
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Telephone | 207-883-0069
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Fax | 207-883-0999
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD21679
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 242806
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 242806
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | MD21679
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License Number State | ME
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