Provider Demographics
NPI:1902898083
Name:BRADLEY KALBAUGH, VALENTINA (MD)
Entity Type:Individual
Prefix:MS
First Name:VALENTINA
Middle Name:
Last Name:BRADLEY KALBAUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:VALENTINA
Other - Middle Name:
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2230 SW 19TH AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1391
Mailing Address - Country:US
Mailing Address - Phone:352-237-4133
Mailing Address - Fax:352-237-7728
Practice Address - Street 1:2121 SW 22ND PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7766
Practice Address - Country:US
Practice Address - Phone:352-237-4133
Practice Address - Fax:352-237-7728
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94814207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH62180Medicare UPIN