Provider Demographics
NPI:1235207077
Name:BARTER, BRADLEY A (DO)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:A
Last Name:BARTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 HOSPITAL DR STE 3
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-1828
Mailing Address - Country:US
Mailing Address - Phone:814-699-9069
Mailing Address - Fax:814-204-1345
Practice Address - Street 1:221 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-1826
Practice Address - Country:US
Practice Address - Phone:814-699-9069
Practice Address - Fax:814-204-1345
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012456207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01948723Medicaid
PA01948723Medicaid
PA068852KAOMedicare ID - Type UnspecifiedMEDICARE#