Provider Demographics
NPI:1295774040
Name:CARMAN, BRADLEY D (DO FACOS)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:D
Last Name:CARMAN
Suffix:
Gender:M
Credentials:DO FACOS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:400 MATTHEW ST
Practice Address - Street 2:SUITE 401
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1644
Practice Address - Country:US
Practice Address - Phone:740-374-2252
Practice Address - Fax:740-374-4974
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004869208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000696936OtherANTHEM
OH0817754Medicaid
OH000000490579OtherANTHEM
OH2034873Medicaid
OHP00789302OtherRRMCR
WV0125817000Medicaid
OH0742583Medicare PIN
OHP00789302OtherRRMCR
E76119Medicare UPIN
OH2034873Medicaid