Healthcare Provider Details

I. General information

NPI: 1417037508
Provider Name (Legal Business Name): MARK E. BRADO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7452 FULTON DR NW
MASSILLON OH
44646-9393
US

IV. Provider business mailing address

1055 APPLEGROVE ST NW
NORTH CANTON OH
44720-6080
US

V. Phone/Fax

Practice location:
  • Phone: 330-830-6110
  • Fax: 330-833-2780
Mailing address:
  • Phone: 330-499-4338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-00-4904
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: