Provider Demographics
NPI:1366448730
Name:LEMON, BRADLEY T (DPM, FACFS)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:T
Last Name:LEMON
Suffix:
Gender:M
Credentials:DPM, FACFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 772
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-0772
Mailing Address - Country:US
Mailing Address - Phone:302-629-3000
Mailing Address - Fax:302-629-3080
Practice Address - Street 1:543 N SHIPLEY ST
Practice Address - Street 2:STE C
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-2339
Practice Address - Country:US
Practice Address - Phone:302-629-3000
Practice Address - Fax:302-629-3080
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE10000121213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE2161OtherCOVENTRY
DE2220599000OtherAMERIHEALTH
DE510401832OtherBLUE CROSS BLUE SHIELD
DE0000776817Medicaid
DECIGNAOther8699345001
DE3314440OtherAETNA - PPO
DE3316680OtherAETNA - HMO
DE448142OtherOPTIMUM CHOICE
DEP00062710OtherRAILROAD MEDICARE
DE5066550001Medicare NSC
DE2161OtherCOVENTRY
DE1548301005Medicare NSC
DE510401832OtherBLUE CROSS BLUE SHIELD
DE1366448730Medicare NSC