MEDICARE: DARIN WALTER STANLEY BRADLEY 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
1	363AM0700X	Medical Physician Assistant	055-0030633	VT
2	363AM0700X	Medical Physician Assistant	0010-11814	NC

General Provider Information

NPI Number	:	1679568349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARIN WALTER STANLEY BRADLEY PA-C

Provider Business Mailing Address
First Line	:	906 DAVIT LN
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28560-7204
Country	:	US
Telephone Number	:	802-989-1305
Fax Number	:

Provider Business Practice Location Address
First Line	:	2002 S GLENBURNIE RD STE 100
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-5229
Country	:	US
Telephone Number	:	252-631-5188
Fax Number	:

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	03/12/2024

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