Provider Demographics
NPI:1023013513
Name:BRADLEY, ELIZABETH A (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:THURHEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:857 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1541
Mailing Address - Country:US
Mailing Address - Phone:610-664-2951
Mailing Address - Fax:610-664-2131
Practice Address - Street 1:857 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19072-1541
Practice Address - Country:US
Practice Address - Phone:610-664-2951
Practice Address - Fax:610-664-2131
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063085L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01862091Medicaid
NY01862091Medicaid
NYRA0428Medicare ID - Type Unspecified