Provider Demographics
NPI:1487692984
Name:WINSTON, BRADLEY MORKEN (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:MORKEN
Last Name:WINSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 WISSEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1608
Mailing Address - Country:US
Mailing Address - Phone:302-422-6170
Mailing Address - Fax:
Practice Address - Street 1:375 MULLET RUN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5373
Practice Address - Country:US
Practice Address - Phone:302-424-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0004093208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEF98740Medicare UPIN