Provider Demographics
NPI:1336124247
Name:FOX, BRADLEY P (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:P
Last Name:FOX
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 1:3413 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2678
Mailing Address - Country:US
Mailing Address - Phone:814-868-9828
Mailing Address - Fax:814-868-8561
Practice Address - Street 1:3413 CHERRY ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2678
Practice Address - Country:US
Practice Address - Phone:814-868-9828
Practice Address - Fax:814-868-8561
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD050885L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine