Healthcare Provider Details

I. General information

NPI: 1073690210
Provider Name (Legal Business Name): BRADLEY JESS MARCUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ASHLEY AVENUE, SUITE 309 MEDICAL UNIVERSITY OF SOUTH CAROLINA, DEPT OF PATH
CHARLESTON SC
29525-8905
US

IV. Provider business mailing address

5700 SOUTHWYCK BLVD
TOLEDO OH
43614-1509
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-3121
  • Fax: 843-792-3537
Mailing address:
  • Phone: 800-288-8325
  • Fax: 419-866-5453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number25783
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: