Provider Demographics
NPI:1932105368
Name:MANIN, BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:MANIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8250 OLD YORK RD # 2
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1514
Mailing Address - Country:US
Mailing Address - Phone:215-885-8550
Mailing Address - Fax:215-885-8570
Practice Address - Street 1:8250 OLD YORK RD # 2
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1514
Practice Address - Country:US
Practice Address - Phone:215-885-8550
Practice Address - Fax:215-885-8570
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD054054L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA774530Medicare PIN