Provider Demographics
NPI:1285617241
Name:GOAD, BRADLEY J (DO)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
Last Name:GOAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6701 PETERS CREEK RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-4060
Mailing Address - Country:US
Mailing Address - Phone:800-765-7130
Mailing Address - Fax:888-500-1891
Practice Address - Street 1:6701 PETERS CREEK RD STE 110
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-4060
Practice Address - Country:US
Practice Address - Phone:800-765-7130
Practice Address - Fax:888-500-1891
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01414207RH0002X
VA0102-201348207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1285617241Medicaid
VA00X5756M01Medicare PIN
NC2401635Medicare PIN
H69219Medicare UPIN