Healthcare Provider Details

I. General information

NPI: 1093006942
Provider Name (Legal Business Name): BRADLEY REID HERRIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 WALBERT AVE STE 202
ALLENTOWN PA
18104-6630
US

IV. Provider business mailing address

3151 WALBERT AVE STE 202
ALLENTOWN PA
18104-6630
US

V. Phone/Fax

Practice location:
  • Phone: 484-658-5437
  • Fax:
Mailing address:
  • Phone: 484-658-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60748498
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: