Provider Demographics
NPI:1669414553
Name:BRADLEY, EARL B (MD)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:B
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 HIGHWAY ONE
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-9641
Mailing Address - Country:US
Mailing Address - Phone:302-645-0222
Mailing Address - Fax:302-645-0899
Practice Address - Street 1:1503 HIGHWAY ONE
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-9641
Practice Address - Country:US
Practice Address - Phone:302-645-0222
Practice Address - Fax:302-645-0899
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-1004285208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001097002OtherDELAWARE PHYSICIANS CARE
DEE96011OtherBCBS DE
DE0001097002Medicaid
DE0895293000OtherAMERIHEALTH
DE883092OtherMAMSI
DEE96011OtherBCBS DE