Dickerson, Bradford Clark

Dickerson, Bradford Clark is an individual health care provider with primary practice located at 15 Parkman St Wacc 835, Boston MA 02114-3117. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Dickerson, Bradford Clark can be contacted via phone (617) 726-1728.

Contact Information

Primary practice address
15 Parkman St Wacc 835 Boston MA 02114-3117
Phone: (617) 726-1728
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 216084 Massachusetts

Profile Details

NPI number 1184615700
LBN Legal business name Dickerson, Bradford Clark
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 2nd, 2005
Last updated Nov 6th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184615700 NPPES
Massachusetts MEDICAID 2018811
Massachusetts Other J26662
Massachusetts Other 216084

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