Bradley, Evan S.

Bradley, Evan S. is an individual health care provider with primary practice located at 55 Lake Ave N , Worcester MA 01655-0002. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Medical Toxicology, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Bradley, Evan S. can be contacted via phone (508) 421-1400.

Contact Information

Primary practice address
55 Lake Ave N Worcester MA 01655-0002
Phone: (508) 421-1400
Fax: (508) 421-1490
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Medical Toxicology 207PT0002X 269735 Massachusetts
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 269735 Massachusetts

Profile Details

NPI number 1609289354
LBN Legal business name Bradley, Evan S.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 10th, 2014
Last updated Nov 9th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609289354 NPPES
Massachusetts MEDICAID 110118825A

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