Provider Demographics
NPI:1699178210
Name:BARNES, BRADLEY JOSEPH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:JOSEPH
Last Name:BARNES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 MACK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5375
Mailing Address - Country:US
Mailing Address - Phone:513-981-6784
Mailing Address - Fax:
Practice Address - Street 1:3050 MACK RD STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5375
Practice Address - Country:US
Practice Address - Phone:513-981-6784
Practice Address - Fax:513-215-9397
Is Sole Proprietor?:No
Enumeration Date:2014-09-28
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50004137RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant