Provider Demographics
NPI:1619910627
Name:WEISNER, BRADLEY KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:KENT
Last Name:WEISNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 36488
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28236-6488
Mailing Address - Country:US
Mailing Address - Phone:704-248-3400
Mailing Address - Fax:704-337-8387
Practice Address - Street 1:1450 MATTHEWS TOWNSHIP PKWY
Practice Address - Street 2:SUITE 350
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2387
Practice Address - Country:US
Practice Address - Phone:704-841-8877
Practice Address - Fax:704-841-8188
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400668208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC23482OtherPARTNERS PROVIDER#
NC340016171OtherRAILROAD MCRE PROV#
NC86336OtherBCBS NC INDI PROV#
NC340016171OtherRAILROAD MCRE PROV#
NCF80766Medicare UPIN
NC86336OtherBCBS NC INDI PROV#
NC2198415FMedicare ID - Type Unspecified