Provider Demographics
NPI:1659374262
Name:PETERS, BRADLEY ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ROBERT
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5655 HUDSON DR STE 210
Mailing Address - Street 2:ARIS RADIOLOGY
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4455
Mailing Address - Country:US
Mailing Address - Phone:330-655-1869
Mailing Address - Fax:330-655-3828
Practice Address - Street 1:200 OAKSIDE LN
Practice Address - Street 2:STE A
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-6416
Practice Address - Country:US
Practice Address - Phone:770-479-1945
Practice Address - Fax:770-479-1948
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2016-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0518902085R0202X
NY2026732085R0202X
AL266442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000964268LMedicaid
GA000964268LMedicaid
G83373Medicare UPIN