Provider Demographics
NPI:1265960074
Name:WASSER, BRADLEY MITCHELL (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:MITCHELL
Last Name:WASSER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 RIDGEWOOD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1286
Mailing Address - Country:US
Mailing Address - Phone:610-376-8691
Mailing Address - Fax:
Practice Address - Street 1:2240 RIDGEWOOD RD STE 100
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1286
Practice Address - Country:US
Practice Address - Phone:610-376-8691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD474655208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist