Provider Demographics
NPI:1760419865
Name:HOWARD, BRADLEY STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:STEVEN
Last Name:HOWARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 LAKEFRONT RD
Mailing Address - Street 2:
Mailing Address - City:TOWNVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29689-2504
Mailing Address - Country:US
Mailing Address - Phone:864-420-3493
Mailing Address - Fax:
Practice Address - Street 1:823 S CHURCH ST STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-4709
Practice Address - Country:US
Practice Address - Phone:864-373-0994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC012883207P00000X, 208D00000X
VA0101240092208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00211206OtherRAILROAD MEDICARE
SC128837Medicaid
D18184Medicare UPIN