Provider Demographics
NPI:1194767905
Name:BRADHAM, ELOISE DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:ELOISE
Middle Name:DANIEL
Last Name:BRADHAM
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:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:SULLIVANS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29482-0126
Mailing Address - Country:US
Mailing Address - Phone:843-870-7518
Mailing Address - Fax:
Practice Address - Street 1:3109 ION AVE
Practice Address - Street 2:
Practice Address - City:SULLIVANS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29482-8606
Practice Address - Country:US
Practice Address - Phone:843-870-7518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13644174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist