Provider Demographics
NPI:1134118540
Name:CROMBIE, BRADLEY H (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:H
Last Name:CROMBIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3515 MASSILLON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-6400
Mailing Address - Country:US
Mailing Address - Phone:330-899-9350
Mailing Address - Fax:330-634-1329
Practice Address - Street 1:65 COMMUNITY RD
Practice Address - Street 2:SUITE C
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2357
Practice Address - Country:US
Practice Address - Phone:330-633-6601
Practice Address - Fax:330-634-1329
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35069243C207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2042891Medicaid
OH2042891Medicaid
OHG61246Medicare UPIN