Provider Demographics
NPI:1457337487
Name:ELROD, BRADLEY E (PA)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:E
Last Name:ELROD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-6927
Mailing Address - Fax:864-512-6687
Practice Address - Street 1:100 HEALTHY WAY
Practice Address - Street 2:SUITE 1250
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-7915
Practice Address - Country:US
Practice Address - Phone:864-512-6927
Practice Address - Fax:864-512-6687
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5863Medicare PIN
SCS94113Medicare UPIN