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General NPI Number Information
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NPI Number | 1861467169
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Entity Type | Individual
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Provider Name | BRADLEY RANDALL SELLERS M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 33 NORTH AVE SUITE 103
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City | TALLMADGE
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State | OH
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Zip | 44278-1925
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Country | US
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Telephone | 330-633-3883
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Fax | 330-633-6658
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Provider Business Mailing Address
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Address Line | 1320 CORPORATE DR STE 200
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City | HUDSON
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State | OH
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Zip | 44236-4442
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Country | US
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Telephone | 330-633-3883
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Fax | 330-253-8629
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35-08-1663-S
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License Number State | OH
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