Provider Demographics
NPI:1013900117
Name:COLE, BRADLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:COLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-448-0219
Mailing Address - Fax:216-448-0220
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-3417
Practice Address - Country:US
Practice Address - Phone:216-448-0219
Practice Address - Fax:216-448-0220
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340079702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2560189Medicaid
OH2560189Medicaid
OHCO4161001Medicare ID - Type Unspecified