Healthcare Provider Details

I. General information

NPI: 1184727299
Provider Name (Legal Business Name): BRADLEY JOSEPH BARTHOLOMEW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3629 PRYTANIA ST
NEW ORLEANS LA
70115-3610
US

IV. Provider business mailing address

3629 PRYTANIA ST
NEW ORLEANS LA
70115-3610
US

V. Phone/Fax

Practice location:
  • Phone: 504-895-9544
  • Fax: 504-895-9548
Mailing address:
  • Phone: 504-895-9544
  • Fax: 504-895-9548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number020301
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: