Provider Demographics
NPI:1558081513
Name:SCHMIDT, BRADLEY ALAN
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ALAN
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 ALLEN RIDGE DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-0128
Mailing Address - Country:US
Mailing Address - Phone:828-974-6187
Mailing Address - Fax:
Practice Address - Street 1:1205 ALLEN RIDGE DR UNIT B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-0128
Practice Address - Country:US
Practice Address - Phone:828-974-6187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program