Provider Demographics
NPI:1083641245
Name:BRADLEY, ELIZABETH PATTILO (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:PATTILO
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE # CFMQ-2
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-1000
Mailing Address - Country:US
Mailing Address - Phone:216-445-6900
Mailing Address - Fax:216-636-3074
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-1000
Practice Address - Country:US
Practice Address - Phone:216-445-6900
Practice Address - Fax:216-636-3074
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13310207R00000X
OH35.131890207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012901Medicaid
NH30206183Medicaid
NH30206183Medicaid
NHRE8782Medicare PIN