Healthcare Provider Details

I. General information

NPI: 1720473549
Provider Name (Legal Business Name): BRADLEY DAVID MCFADDEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E OLENTANGY ST
POWELL OH
43065-9069
US

IV. Provider business mailing address

120 E OLENTANGY ST
POWELL OH
43065-9069
US

V. Phone/Fax

Practice location:
  • Phone: 614-898-1211
  • Fax: 614-961-1096
Mailing address:
  • Phone: 614-898-1211
  • Fax: 614-961-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.013082
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: