Provider Demographics
NPI:1477909356
Name:UNRUH, BRADLEY THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:THOMAS
Last Name:UNRUH
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:MEDICAL CENTER BLVD
Mailing Address - Street 2:RADIOLOGY
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-1088
Mailing Address - Country:US
Mailing Address - Phone:336-716-5222
Mailing Address - Fax:336-716-1278
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:RADIOLOGY
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-1088
Practice Address - Country:US
Practice Address - Phone:336-716-5222
Practice Address - Fax:336-716-1278
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10056529207R00000X
NC2021-006352085R0202X, 2085B0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program