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1871660555

NPI Code Detail

MEDICARE: JOHN C. BRADLEY CRNA

MEDICARE: JOHN C. BRADLEY CRNA

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	367500000X	Certified Registered Nurse Anesthetist	R118379	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00728709	OTHER	MD	MEDICARE RAILROAD (GRP PTAN CJ8689)
6	P00745073	OTHER	MD	MEDICARE RAILROAD (GRP PTAN DD6120)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	KBC1CH	OTHER	MD	CAREFIRST BCBS
3	R118379	OTHER	MD	LICENSE
4	S417 0030	OTHER	DC	CAREFIRST BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871660555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN C. BRADLEY CRNA

Provider Business Mailing Address
First Line	:	PO BOX 18139
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27619-8139
Country	:	US
Telephone Number	:	636-549-2380
Fax Number	:	314-569-5974

Provider Business Practice Location Address
First Line	:	9104 MARKET ST
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28411-7994
Country	:	US
Telephone Number	:	301-694-3400
Fax Number	:	301-694-3620

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	04/30/2011

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Directions to “ JOHN C. BRADLEY CRNA” Practice Location

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