Healthcare Provider Details

I. General information

NPI: 1417123118
Provider Name (Legal Business Name): BRADLEY MICHAEL MCCRADY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 09/28/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 LAMB CIR STE 380
CHRISTIANSBURG VA
24073-6345
US

IV. Provider business mailing address

2900 LAMB CIR STE 380
CHRISTIANSBURG VA
24073-6345
US

V. Phone/Fax

Practice location:
  • Phone: 540-510-6200
  • Fax: 540-857-5306
Mailing address:
  • Phone: 540-510-6200
  • Fax: 540-857-5306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2557
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number0102202775
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: