Provider Demographics
NPI:1275597809
Name:BRADEN, GEOFFREY L (MD)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:L
Last Name:BRADEN
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 1:1515 SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1675
Mailing Address - Country:US
Mailing Address - Phone:302-645-3499
Mailing Address - Fax:302-644-4830
Practice Address - Street 1:33663 BAYVIEW MEDICAL DR UNIT 2
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1663
Practice Address - Country:US
Practice Address - Phone:302-645-9325
Practice Address - Fax:302-644-7162
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0028455207RG0100X
UT10439358-1205207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000851110Medicaid
PA000851110Medicaid
PA405465E2PMedicare ID - Type Unspecified