Provider Demographics
NPI:1275553620
Name:RADLEY, MICHAEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:RADLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20310 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-4020
Mailing Address - Country:US
Mailing Address - Phone:301-733-4232
Mailing Address - Fax:
Practice Address - Street 1:17 WESTERN MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5146
Practice Address - Country:US
Practice Address - Phone:301-797-9240
Practice Address - Fax:301-797-4119
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045936207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA966246OtherPA BLUE SHIELD PA LOC
MDW2660003OtherMD BLUE SHIELD REGIONAL
MD53220504OtherMD BLUE SHIELD TRADITIONA
140005761OtherRR MEDICARE
PA436164OtherPA BLUE SHIELD MD LOC
MD597381300Medicaid
PA021489M0TMedicare PIN
MD602L039DMedicare PIN
MDW2660003OtherMD BLUE SHIELD REGIONAL