Provider Demographics
NPI:1861467169
Name:SELLERS, BRADLEY RANDALL (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:RANDALL
Last Name:SELLERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1320 CORPORATE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4442
Mailing Address - Country:US
Mailing Address - Phone:330-633-3883
Mailing Address - Fax:330-253-8629
Practice Address - Street 1:33 NORTH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1925
Practice Address - Country:US
Practice Address - Phone:330-633-3883
Practice Address - Fax:330-633-6658
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-08-1663-S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2345877Medicaid
000000181144OtherTHREE RIVERS HEALTH PLANS
000000341614OtherANTHEM BCBS
729962OtherBUCKEYE COMMUNITY HEALTH
Q039874OtherHOMETOWN HEALTH NETWORK
000000341614OtherUNICARE - LIFE & HEALTH
796OtherSUMMACARE HEALTH PLAN
000000341614OtherUNICARE - LIFE & HEALTH
729962OtherBUCKEYE COMMUNITY HEALTH
OH2345877Medicaid