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NPI Code Detail

MEDICARE: CANDACE ANGELENA BRADLEY D.O.

MEDICARE: CANDACE ANGELENA BRADLEY D.O.
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
1207Q00000XFamily Medicine Physician200200649NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558358234
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDACE ANGELENA BRADLEY D.O.
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1750 KERNERSVILLE MEDICAL PKWY
Second Line :
City : KERNERSVILLE
State : NC
Zip : 27284-7146
Country : US
Telephone Number : 336-564-4866
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2005
Last Update Date : 03/27/2025

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