Provider Demographics
NPI:1780909291
Name:BRADLEY, PATRICK D (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:D
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3800 ELECTRIC RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4549
Mailing Address - Country:US
Mailing Address - Phone:402-998-5125
Mailing Address - Fax:540-299-8538
Practice Address - Street 1:3800 ELECTRIC RD STE 101
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4549
Practice Address - Country:US
Practice Address - Phone:540-299-8512
Practice Address - Fax:540-299-8538
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2023-04-03
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Provider Licenses
StateLicense IDTaxonomies
VA0101255677207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1780909291Medicaid