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NPI Code Detail

MEDICARE: BRIAN S BRADLEY M.D.

MEDICARE: BRIAN S BRADLEY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12080N0001XNeonatal-Perinatal Medicine Physician35-64786OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110256OTHEROHPARAMOUNT
247-00071OTHEROHUNITED HEALTH CARE
32031651OTHEROHAETNA
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5000000129749OTHEROHANTHEM BLUE CROSS
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083611420
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN S BRADLEY M.D.
Provider Business Mailing Address
First Line : PO BOX 12498
Second Line :
City : TOLEDO
State : OH
Zip : 43606-0098
Country : US
Telephone Number : 419-291-2237
Fax Number : 419-479-6193
Provider Business Practice Location Address
First Line : 2142 N COVE BLVD
Second Line :
City : TOLEDO
State : OH
Zip : 43606-3895
Country : US
Telephone Number : 419-291-4225
Fax Number : 419-479-6193
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 08/11/2010

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Directions to “ BRIAN S BRADLEY M.D.” Practice Location

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