Provider Demographics
NPI:1558331280
Name:FELL, BRADLEY A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:A
Last Name:FELL
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:PO BOX 802
Mailing Address - Street 2:ONE PARK WAY
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-0802
Mailing Address - Country:US
Mailing Address - Phone:814-676-5444
Mailing Address - Fax:814-676-0342
Practice Address - Street 1:ONE PARK WAY
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-0802
Practice Address - Country:US
Practice Address - Phone:814-676-5444
Practice Address - Fax:814-676-0342
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056270L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015982500005Medicaid
PA0015982500005Medicaid