Healthcare Provider Details

I. General information

NPI: 1073694535
Provider Name (Legal Business Name): KATHLEEN A BRADLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 HURFFVILLE CROSSKEYS RD STE 160
SEWELL NJ
08080
US

IV. Provider business mailing address

2000 CRAWFORD PL STE 200
MOUNT LAUREL NJ
08054-3954
US

V. Phone/Fax

Practice location:
  • Phone: 856-341-8200
  • Fax: 856-341-8215
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA06165200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: