Provider Demographics
NPI:1770690216
Name:PATTERSON, BRADLEY S (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:S
Last Name:PATTERSON
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-655-4111
Mailing Address - Fax:859-655-4815
Practice Address - Street 1:1500 JAMES SIMPSON JR WAY
Practice Address - Street 2:STE 201
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-0801
Practice Address - Country:US
Practice Address - Phone:859-655-4111
Practice Address - Fax:859-655-4814
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.084601207Q00000X
KY38059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2494475Medicaid
KY7100087040Medicaid
00810641Medicare PIN
KY7100087040Medicaid
I11474Medicare UPIN
KY00858008Medicare PIN