Provider Demographics
NPI:1669448148
Name:BRADLEY, ELIZABETH LEIGH (M D)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LEIGH
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HOSPITAL AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-9244
Mailing Address - Country:US
Mailing Address - Phone:336-846-7238
Mailing Address - Fax:336-846-2117
Practice Address - Street 1:200 HOSPITAL AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9244
Practice Address - Country:US
Practice Address - Phone:336-846-7238
Practice Address - Fax:336-846-2117
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35799207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8917483Medicaid
NC2204648Medicare ID - Type UnspecifiedMEDICARE ID NO
NC8917483Medicaid