Provider Demographics
NPI:1134407133
Name:PIERCE, BRADLEY ROBERT (PA)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ROBERT
Last Name:PIERCE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-8809
Mailing Address - Country:US
Mailing Address - Phone:828-324-2800
Mailing Address - Fax:828-294-9160
Practice Address - Street 1:2165 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-8809
Practice Address - Country:US
Practice Address - Phone:828-324-2800
Practice Address - Fax:828-294-9160
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003359363A00000X
NC0010-12541363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0070635Medicaid
NC1134407133Medicaid
OHH026140Medicare PIN
OH0070635Medicaid
OHH026141Medicare PIN