Provider Demographics
NPI:1043504152
Name:KING, BRADLEY MARK (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:MARK
Last Name:KING
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:BRADLEY
Other - Middle Name:MARK
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1016 KIRKPATRICK RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9714
Mailing Address - Country:US
Mailing Address - Phone:336-228-0254
Mailing Address - Fax:336-584-0101
Practice Address - Street 1:1016 KIRKPATRICK RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9714
Practice Address - Country:US
Practice Address - Phone:336-228-0254
Practice Address - Fax:336-584-0101
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201500553207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1043504152Medicaid