Provider Demographics
NPI:1861477143
Name:BRADLEY, BRUCE A (DO)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:118 NATURE PARK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6960
Mailing Address - Country:US
Mailing Address - Phone:724-836-5540
Mailing Address - Fax:724-836-5548
Practice Address - Street 1:118 NATURE PARK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6960
Practice Address - Country:US
Practice Address - Phone:724-836-5540
Practice Address - Fax:724-836-5548
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006954L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001461835Medicaid
10923530OtherCAQH
758349Medicare PIN