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NPI Code Detail

MEDICARE: BRADLEY E KOLESAR PA-C

MEDICARE: BRADLEY E KOLESAR PA-C
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
1363A00000XPhysician Assistant0110003073VA

General Provider Information

NPI Number : 1356676225
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY E KOLESAR PA-C
Provider Business Mailing Address
First Line : PO BOX 780125
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19178-0125
Country : US
Telephone Number : 804-922-4844
Fax Number :
Provider Business Practice Location Address
First Line : 131 JENNICK DR
Second Line :
City : COLONIAL HEIGHTS
State : VA
Zip : 23834-4905
Country : US
Telephone Number : 804-526-5888
Fax Number : 804-526-5401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2009
Last Update Date : 02/19/2026

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Directions to “ BRADLEY E KOLESAR PA-C” Practice Location

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