MEDICARE: MISS LAUREN 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	208000000X	Pediatrics Physician	209892	NC
2	2080P0214X	Pediatric Pulmonology Physician	2018-00867	NC

General Provider Information

NPI Number	:	1790162774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LAUREN BRADFORD MD

Provider Business Mailing Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	336-713-4500
Fax Number	:	336-713-4501

Provider Business Practice Location Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-7220
Country	:	US
Telephone Number	:	336-716-4500
Fax Number	:	336-713-4501

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

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	11/10/2021

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Directions to “ MISS LAUREN BRADFORD MD” Practice Location

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