Provider Demographics
NPI:1740642289
Name:LIND, BRADLEY WILLIAM (DPM)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:WILLIAM
Last Name:LIND
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 HWY 49 SOUTH
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075
Mailing Address - Country:US
Mailing Address - Phone:704-455-2999
Mailing Address - Fax:704-455-1624
Practice Address - Street 1:3800 HWY 49 SOUTH
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075
Practice Address - Country:US
Practice Address - Phone:704-455-2999
Practice Address - Fax:704-455-1624
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC692213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty