Provider Demographics
NPI:1215461819
Name:BRADHAM, MEGAN EPPERSON (MD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:EPPERSON
Last Name:BRADHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 N KALAHEO AVE STE C306
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1873
Mailing Address - Country:US
Mailing Address - Phone:808-263-7383
Mailing Address - Fax:808-237-5828
Practice Address - Street 1:970 N KALAHEO AVE STE C306
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1873
Practice Address - Country:US
Practice Address - Phone:808-263-7383
Practice Address - Fax:808-237-5828
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD21155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine