Provider Demographics
NPI:1881811537
Name:SEVIN, BRADLEY HARVEY (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:HARVEY
Last Name:SEVIN
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 1:829 SPRUCE ST
Mailing Address - Street 2:SUITE #302
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5752
Mailing Address - Country:US
Mailing Address - Phone:215-829-5757
Mailing Address - Fax:215-829-2070
Practice Address - Street 1:829 SPRUCE ST
Practice Address - Street 2:SUITE #302
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5752
Practice Address - Country:US
Practice Address - Phone:215-829-5757
Practice Address - Fax:215-829-2070
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD011867E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASE158614Medicare ID - Type Unspecified
PAB40226Medicare UPIN