Tisdale, Bradford W
Tisdale, Bradford W is an individual health care provider with primary practice located at 3745 Holland Rd , Virginia Beach VA 23452-2847. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Tisdale, Bradford W can be contacted via phone (757) 962-8720.Contact Information
Primary practice address
3745 Holland Rd
Virginia Beach VA 23452-2847
Phone: (757) 962-8720
Fax: (757) 507-9004
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 0101034354 | Virginia |
Profile Details
NPI number | 1871568139 |
---|---|
LBN Legal business name | Tisdale, Bradford W |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Feb 21st, 2006 |
Last updated | Dec 27th, 2013 - about 11 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1871568139 | NPPES |
Virginia | MEDICAID | 005611695 |
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