Provider Demographics
NPI:1801889761
Name:BRADLEY, MAHLON ARTHUR (MD)
Entity type:Individual
Prefix:
First Name:MAHLON
Middle Name:ARTHUR
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:ATT: CVMC-FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-225-3970
Mailing Address - Fax:802-225-1733
Practice Address - Street 1:7 PAGE HILL RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-3531
Practice Address - Country:US
Practice Address - Phone:603-752-2300
Practice Address - Fax:603-752-1836
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260251207X00000X
VT042.0012673207X00000X, 207XX0005X
MA57227207XX0005X
NH19700207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ06476OtherBLUE CROSS BLUE SHIELD
0028303OtherNEIGHBORHOOD HEALTH PLAN
0901140OtherUNITED HEALTHCARE
VT1021940Medicaid
39355OtherFALLON COMMUNITY HEALTH
52663OtherCIGNA
P00018882OtherRAILROAD MEDICARE
057227OtherTUFTS HEALTH PLAN
171031OtherHARVARD PILGRIM
2997952OtherAETNA
MA3025101Medicaid
522367186OtherUNICARE
MA3025101Medicaid
0901140OtherUNITED HEALTHCARE
MAB74860Medicare UPIN