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NPI Code Detail

MEDICARE: BRADLEY A. NACE

MEDICARE: BRADLEY A. NACE
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
1363A00000XPhysician AssistantMA003465LPA
2363A00000XPhysician AssistantPA.0003736CO
3363AS0400XSurgical Physician Assistant2149NH
4363A00000XPhysician AssistantPA-2307ID

Other Identifiers

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

General Provider Information

NPI Number : 1972501849
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY A. NACE
Provider Business Mailing Address
First Line : 240 S MAIN ST
Second Line :
City : WOLFEBORO
State : NH
Zip : 03894-4455
Country : US
Telephone Number : 603-569-7690
Fax Number : 603-569-7664
Provider Business Practice Location Address
First Line : 240 S MAIN ST
Second Line :
City : WOLFEBORO
State : NH
Zip : 03894-4455
Country : US
Telephone Number : 603-569-7690
Fax Number : 603-569-7664
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2005
Last Update Date : 01/31/2024

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