Provider Demographics
NPI:1609981992
Name:BRADLEY, MICHAEL JOHN (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 OAK GROVE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17963-1226
Mailing Address - Country:US
Mailing Address - Phone:570-345-3321
Mailing Address - Fax:570-345-6470
Practice Address - Street 1:8 OAK GROVE RD STE 1
Practice Address - Street 2:
Practice Address - City:PINE GROVE
Practice Address - State:PA
Practice Address - Zip Code:17963-1226
Practice Address - Country:US
Practice Address - Phone:570-345-3321
Practice Address - Fax:570-345-6470
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH81258Medicare UPIN
068722NOWMedicare PIN