MEDICARE: MR. THOMAS F BRADBERRY 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	207R00000X	Internal Medicine Physician	17777	SC

Other Identifiers

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

General Provider Information

NPI Number	:	1649283748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS F BRADBERRY MD

Provider Business Mailing Address
First Line	:	2033 MEDICAL PARK DR
Second Line	:
City	:	NEWBERRY
State	:	SC
Zip	:	29108-2249
Country	:	US
Telephone Number	:	803-276-5188
Fax Number	:	803-276-9317

Provider Business Practice Location Address
First Line	:	2033 MEDICAL PARK DR
Second Line	:
City	:	NEWBERRY
State	:	SC
Zip	:	29108-2249
Country	:	US
Telephone Number	:	803-276-5188
Fax Number	:	803-276-9317

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	05/13/2011

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