Provider Demographics
NPI:1407085905
Name:BRADLEY, ERIN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:ELIZABETH
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:ELIZABETH
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:193 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2808
Mailing Address - Country:US
Mailing Address - Phone:781-254-6429
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:FOUNDERS 114
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant