Provider Demographics
NPI:1477077220
Name:MARCINEK, BRADLEY THOMAS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:THOMAS
Last Name:MARCINEK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MAIN ST.
Mailing Address - Street 2:PO BOX 425846
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-9998
Mailing Address - Country:US
Mailing Address - Phone:516-410-0372
Mailing Address - Fax:
Practice Address - Street 1:185 PILGRIM RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5324
Practice Address - Country:US
Practice Address - Phone:617-632-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6222363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical