Provider Demographics
NPI:1649217712
Name:WADINGTON, BRADLEY JON (DMP)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JON
Last Name:WADINGTON
Suffix:
Gender:M
Credentials:DMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 ASHEVILLE HWY
Mailing Address - Street 2:UNIT 10
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-1500
Mailing Address - Country:US
Mailing Address - Phone:828-697-8686
Mailing Address - Fax:828-697-0960
Practice Address - Street 1:2315 ASHEVILLE HWY
Practice Address - Street 2:UNIT 10
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-1500
Practice Address - Country:US
Practice Address - Phone:828-697-8686
Practice Address - Fax:828-697-0960
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC488213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790805JMedicaid
NC488OtherSTATE LICENSE
NC5324590001Medicare NSC
NC488OtherSTATE LICENSE