MEDICARE: DR. BRADLEY RAYMOND PENDER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	L1428	TX

General Provider Information

NPI Number	:	1225029119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY RAYMOND PENDER MD

Provider Business Mailing Address
First Line	:	218 AIKEN HUNT CIR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-8405
Country	:	US
Telephone Number	:	210-602-9051
Fax Number	:

Provider Business Practice Location Address
First Line	:	6439 GARNERS FERRY RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1638
Country	:	US
Telephone Number	:	803-776-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	02/22/2017

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