Provider Demographics
NPI:1801878046
Name:BRADLEY, ALAN BELMONT (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:BELMONT
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 1:1220 E ELM ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2850
Mailing Address - Country:US
Mailing Address - Phone:419-224-2632
Mailing Address - Fax:419-222-2731
Practice Address - Street 1:1220 E ELM ST
Practice Address - Street 2:SUITE 204
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2850
Practice Address - Country:US
Practice Address - Phone:419-224-2632
Practice Address - Fax:419-222-2731
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042423207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0492864Medicaid
OHA80300Medicare UPIN
OHBR4139431Medicare PIN