Provider Demographics
NPI:1346203437
Name:BRADLEY, CRAIG A (DO)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
Last Name:BRADLEY
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 1:2214 SOUTH QUEEN STREET
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402
Mailing Address - Country:US
Mailing Address - Phone:717-741-3831
Mailing Address - Fax:717-741-2764
Practice Address - Street 1:2214 SOUTH QUEEN STREET
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402
Practice Address - Country:US
Practice Address - Phone:717-741-3831
Practice Address - Fax:717-741-2764
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004315L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
02619000OtherKEYSTONE
D98747Medicare UPIN
02619000OtherKEYSTONE