Provider Demographics
NPI:1376591685
Name:PIATT, BRADFORD M (MD)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:M
Last Name:PIATT
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 1:970 DEWING AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4278
Mailing Address - Country:US
Mailing Address - Phone:925-297-6460
Mailing Address - Fax:510-451-2352
Practice Address - Street 1:970 DEWING AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4278
Practice Address - Country:US
Practice Address - Phone:510-451-0780
Practice Address - Fax:510-451-2352
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG594472085B0100X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG59447OtherMEDICAL LICENSE
CA00G594470Medicare PIN
CAP00656282Medicare PIN
CABJ398ZMedicare PIN
CA00G594473Medicare PIN