Provider Demographics
NPI:1639708522
Name:CLEMENS, BRADLEY HOBART (DO)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:HOBART
Last Name:CLEMENS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1215 LEE ST BOX 801002
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0816
Mailing Address - Country:US
Mailing Address - Phone:434-243-0223
Mailing Address - Fax:434-244-7584
Practice Address - Street 1:1215 LEE ST # 801002
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-2526
Practice Address - Country:US
Practice Address - Phone:434-243-0223
Practice Address - Fax:434-244-7584
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151014362207R00000X
390200000X
VA0116037531390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine