Provider Demographics
NPI:1124063441
Name:BRADFORD, LESLIE SIRIYA (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:SIRIYA
Last Name:BRADFORD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CAMPUS DR UNIT 125
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7171
Mailing Address - Country:US
Mailing Address - Phone:207-883-0069
Mailing Address - Fax:207-883-0999
Practice Address - Street 1:100 CAMPUS DR STE 125
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7171
Practice Address - Country:US
Practice Address - Phone:207-883-0069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD21679207V00000X, 207VX0201X
MA242806207V00000X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400422720OtherMEDICARE
MA110085476AMedicaid
MEE400422717OtherMEDICARE