Provider Demographics
NPI:1356430854
Name:MACKLER, BRADLEY PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:PAUL
Last Name:MACKLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:924 MIDDLEFORD RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3604
Mailing Address - Country:US
Mailing Address - Phone:302-629-2229
Mailing Address - Fax:302-629-2285
Practice Address - Street 1:924 MIDDLEFORD RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3604
Practice Address - Country:US
Practice Address - Phone:302-629-2229
Practice Address - Fax:302-629-2285
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004336207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE100010338OtherMEDICARE RAILROAD
DE505182OtherAETNA
DE0000559901Medicaid
DE421862OtherOPT CHOICE/MDIPA
DE0196029 00OtherMARYLAND MEDICAID
DE421862OtherOPT CHOICE
DE1939OtherCOVENTRY
DE2714OtherBLUE CROSS OF MARYLAND
DE522065442OtherCARELINK
DEPAL58270210001OtherCIGNA
DE522065442OtherBCBS OF DELAWARE
DEE95484Medicare UPIN
DEG01627NO1Medicare PIN