Healthcare Provider Details

I. General information

NPI: 1942959390
Provider Name (Legal Business Name): BRADLEY JAMES RIVOTTO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N 17TH ST STE 300
ALLENTOWN PA
18104-5052
US

IV. Provider business mailing address

400 N 17TH ST STE 300
ALLENTOWN PA
18104-5052
US

V. Phone/Fax

Practice location:
  • Phone: 610-969-3500
  • Fax:
Mailing address:
  • Phone: 610-969-3500
  • Fax: 610-969-3605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS025713
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: