MEDICARE: DR. BRAD BATES VMD

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	174M00000X	Veterinarian	BV012482	PA
2	174M00000X	Veterinarian	29VI00668200	NJ
3	174M00000X	Veterinarian	N1-0002713	DE

General Provider Information

NPI Number	:	1710357421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAD BATES VMD

Provider Business Mailing Address
First Line	:	3139 W THOMPSON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-4421
Country	:	US
Telephone Number	:	570-704-8491
Fax Number	:

Provider Business Practice Location Address
First Line	:	3139 W THOMPSON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-4421
Country	:	US
Telephone Number	:	570-704-8491
Fax Number	:

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

Provider Enumeration Date	:	10/07/2015
Last Update Date	:	10/07/2015

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