Provider Demographics
NPI:1588169858
Name:BRADSHAW, RHIANNON JEAN (MD)
Entity type:Individual
Prefix:
First Name:RHIANNON
Middle Name:JEAN
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RHIANNON
Other - Middle Name:JEAN
Other - Last Name:ECSEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:545 BARNHILL DR # EH232
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5112
Mailing Address - Country:US
Mailing Address - Phone:317-278-0394
Mailing Address - Fax:
Practice Address - Street 1:545 BARNHILL DR # EH232
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5112
Practice Address - Country:US
Practice Address - Phone:317-278-0394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01090576A208200000X
TXBP10062888208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery