1801889761 NPI number — MAHLON ARTHUR BRADLEY MD

Table of content: MAHLON ARTHUR BRADLEY MD (NPI 1801889761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801889761 NPI number — MAHLON ARTHUR BRADLEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADLEY
Provider First Name:
MAHLON
Provider Middle Name:
ARTHUR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801889761
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 547
Provider Second Line Business Mailing Address:
ATT: CVMC-FINANCE DEPT
Provider Business Mailing Address City Name:
BARRE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05641-0547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-225-3970
Provider Business Mailing Address Fax Number:
802-225-1733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 PAGE HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03570-3531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-752-2300
Provider Business Practice Location Address Fax Number:
603-752-1836
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  260251 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 042.0012673 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X , with the licence number: 57227 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X , with the licence number: 042.0012673 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 19700 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: J06476 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0028303 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0901140 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1021940 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39355 . This is a "FALLON COMMUNITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 52663 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00018882 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 057227 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 171031 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2997952 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3025101 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 522367186 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".




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