MEDICARE: DR. ELOISE DANIEL BRADHAM 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
1	174400000X	Specialist	13644	SC
2	207L00000X	Anesthesiology Physician	13644	SC

General Provider Information

NPI Number	:	1194767905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELOISE DANIEL BRADHAM M.D

Provider Business Mailing Address
First Line	:	PO BOX 126
Second Line	:
City	:	SULLIVANS ISLAND
State	:	SC
Zip	:	29482-0126
Country	:	US
Telephone Number	:	843-870-7518
Fax Number	:

Provider Business Practice Location Address
First Line	:	3109 ION AVE
Second Line	:
City	:	SULLIVANS ISLAND
State	:	SC
Zip	:	29482-8606
Country	:	US
Telephone Number	:	843-870-7518
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	09/16/2015

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