MEDICARE: RONALD L BRADLEY PA

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	363A00000X	Physician Assistant	0110002781	VA

General Provider Information

NPI Number	:	1962662130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD L BRADLEY PA

Provider Business Mailing Address
First Line	:	PO BOX 71690
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23255-1690
Country	:	US
Telephone Number	:	804-288-2830
Fax Number	:	804-288-2850

Provider Business Practice Location Address
First Line	:	13801 ST FRANCIS BLVD STE 200
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-3206
Country	:	US
Telephone Number	:	804-379-2414
Fax Number	:	804-379-2413

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

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	05/18/2020

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Directions to “ RONALD L BRADLEY PA” Practice Location

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