Provider Demographics
NPI:1235382235
Name:THOMAS P BRADLEY MD PHD INC
Entity Type:Organization
Organization Name:THOMAS P BRADLEY MD PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:831-333-1719
Mailing Address - Street 1:24571 SILVER CLOUD CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6583
Mailing Address - Country:US
Mailing Address - Phone:831-333-1719
Mailing Address - Fax:831-333-0442
Practice Address - Street 1:24571 SILVER CLOUD CT
Practice Address - Street 2:SUITE 201
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-6583
Practice Address - Country:US
Practice Address - Phone:831-333-1719
Practice Address - Fax:831-333-0442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75220207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAX507Medicare PIN