Provider Demographics
NPI:1619191731
Name:BARKER, BRADLEY D (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:D
Last Name:BARKER
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 1:1120 E BROAD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6306
Mailing Address - Country:US
Mailing Address - Phone:440-326-4410
Mailing Address - Fax:216-201-6913
Practice Address - Street 1:1120 E BROAD ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6306
Practice Address - Country:US
Practice Address - Phone:440-365-8487
Practice Address - Fax:440-365-5486
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3025372Medicaid
OH0779939Medicaid
OH9389631Medicare PIN
OH0779939Medicaid
OHE56083Medicare UPIN