Provider Demographics
NPI:1740280148
Name:BRADLEY, DOUGLAS DAMIEN (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:DAMIEN
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 1:700 RAHWAY AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6634
Mailing Address - Country:US
Mailing Address - Phone:908-688-1999
Mailing Address - Fax:908-688-8180
Practice Address - Street 1:700 RAHWAY AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6634
Practice Address - Country:US
Practice Address - Phone:908-688-1999
Practice Address - Fax:908-688-8180
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMANJ049904207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0459801Medicaid
NJ223537990OtherTAX ID #
NJD19436Medicare UPIN
NJ514170QH2Medicare ID - Type Unspecified