MEDICARE: LESLIE SIRIYA BRADFORD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	MD21679	ME
2	207V00000X	Obstetrics & Gynecology Physician	242806	MA
3	207VX0201X	Gynecologic Oncology Physician	242806	MA
4	207VX0201X	Gynecologic Oncology Physician	MD21679	ME

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E400422720	OTHER	ME	MEDICARE
3	E400422717	OTHER	ME	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124063441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE SIRIYA BRADFORD MD

Provider Business Mailing Address
First Line	:	100 CAMPUS DR UNIT 125
Second Line	:
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-7171
Country	:	US
Telephone Number	:	207-883-0069
Fax Number	:	207-883-0999

Provider Business Practice Location Address
First Line	:	100 CAMPUS DR STE 125
Second Line	:
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-7171
Country	:	US
Telephone Number	:	207-883-0069
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	04/15/2025

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Directions to “ LESLIE SIRIYA BRADFORD MD” Practice Location

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