Provider Demographics
NPI:1154460400
Name:BRADLEY, MARCY (PA)
Entity type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SAVANNAH RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1499
Mailing Address - Country:US
Mailing Address - Phone:302-645-3555
Mailing Address - Fax:
Practice Address - Street 1:26026 PATRIOTS WAY
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-2584
Practice Address - Country:US
Practice Address - Phone:302-934-5962
Practice Address - Fax:302-934-5965
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC50000199363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical