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General NPI Number Information
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NPI Number | 1033102124
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Entity Type | Individual
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Provider Name | BRADLEY A BLACKBURN MD
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Gender | Male
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Dates
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Enumeration Date | 08/24/2005
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 18181 PEARL RD STE A102
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City | STRONGSVILLE
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State | OH
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Zip | 44136-6951
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Country | US
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Telephone | 440-816-4250
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 638269
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City | CINCINNATI
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State | OH
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Zip | 45263-4455
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Country | US
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Telephone | 440-816-4250
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35053437
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License Number State | OH
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