Provider Demographics
NPI:1962491522
Name:SODOWICK, BRADFORD (MD)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:
Last Name:SODOWICK
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 1:1 DOCK ST APT 1501
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3961
Mailing Address - Country:US
Mailing Address - Phone:215-499-7695
Mailing Address - Fax:
Practice Address - Street 1:1 DOCK ST APT 1501
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3961
Practice Address - Country:US
Practice Address - Phone:215-499-7695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050572L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD050572LOtherMD
NJ7485409Medicaid
005628LWHMedicare ID - Type Unspecified