Provider Demographics
NPI:1831250331
Name:BRADLEY, LORELLE E (MD)
Entity type:Individual
Prefix:DR
First Name:LORELLE
Middle Name:E
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 GEORGIA AVE NW
Mailing Address - Street 2:RM 6B42
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060-0001
Mailing Address - Country:US
Mailing Address - Phone:202-865-4554
Mailing Address - Fax:202-865-4558
Practice Address - Street 1:2041 GEORGIA AVE NW
Practice Address - Street 2:RM 6B42
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-865-4554
Practice Address - Fax:202-865-4558
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD33454208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H86223Medicare UPIN
006905K32Medicare ID - Type Unspecified