Provider Demographics
NPI:1962662130
Name:BRADLEY, RONALD L (PA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 71690
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23255-1690
Mailing Address - Country:US
Mailing Address - Phone:804-288-2830
Mailing Address - Fax:804-288-2850
Practice Address - Street 1:13801 ST FRANCIS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3206
Practice Address - Country:US
Practice Address - Phone:804-379-2414
Practice Address - Fax:804-379-2413
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2020-05-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110002781363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant