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NPI Code Detail

MEDICARE: MR. BRADFORD GREGORY LEDZIAN PA-C

MEDICARE: MR. BRADFORD GREGORY LEDZIAN PA-C
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
1363A00000XPhysician Assistant001228CT
2363A00000XPhysician Assistant25MP00085600NJ
3363AS0400XSurgical Physician AssistantPA9107190FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1HI023ZOTHERFLPTAN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952376907
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRADFORD GREGORY LEDZIAN PA-C
Provider Business Mailing Address
First Line : 2415 N ORANGE AVE STE 700
Second Line :
City : ORLANDO
State : FL
Zip : 32804-5521
Country : US
Telephone Number : 407-303-2474
Fax Number : 407-303-0680
Provider Business Practice Location Address
First Line : 2415 N ORANGE AVE STE 700
Second Line :
City : ORLANDO
State : FL
Zip : 32804-5521
Country : US
Telephone Number : 407-303-2474
Fax Number : 407-303-0680
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2006
Last Update Date : 10/01/2020

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