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General NPI Number Information
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NPI Number | 1801107065
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Entity Type | Individual
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Provider Name | KELLY TODD BRADLEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 2864 BENNETTS POND RD
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-7549
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Country | US
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Telephone | 617-733-5485
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Fax |
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Provider Business Mailing Address
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Address Line | 2864 BENNETTS POND RD
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-7549
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Country | US
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Telephone | 617-733-5485
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 34495
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number | 0101276609
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License Number State | VA
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