Healthcare Provider Details

I. General information

NPI: 1588198261
Provider Name (Legal Business Name): THE BRADLEY CENTER INC PCP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5180 CAMPBELLS RUN RD
PITTSBURGH PA
15205-9731
US

IV. Provider business mailing address

5180 CAMPBELLS RUN RD
PITTSBURGH PA
15205-9731
US

V. Phone/Fax

Practice location:
  • Phone: 412-788-8219
  • Fax:
Mailing address:
  • Phone: 412-788-8219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA RENE FOX
Title or Position: CHIEF EXECUTIVE OFFICE
Credential:
Phone: 412-788-8219