Provider Demographics
NPI:1811940646
Name:STEELE, BRADLEY W (M D)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:W
Last Name:STEELE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
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Mailing Address - Street 1:2687 LAKE PARK DR
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9100
Mailing Address - Country:US
Mailing Address - Phone:843-572-0097
Mailing Address - Fax:873-725-9118
Practice Address - Street 1:641 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7165
Practice Address - Country:US
Practice Address - Phone:843-766-9747
Practice Address - Fax:843-766-3399
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC21711208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4437Medicaid
SCGP4437Medicaid
SC8519Medicare PIN