Provider Demographics
NPI:1316463672
Name:BRADLEY H PADDOCK MD
Entity type:Organization
Organization Name:BRADLEY H PADDOCK MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:HOLMES
Authorized Official - Last Name:PADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-725-8656
Mailing Address - Street 1:242 E STATE ST EXT
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-6039
Mailing Address - Country:US
Mailing Address - Phone:518-725-8656
Mailing Address - Fax:518-773-7824
Practice Address - Street 1:242 E STATE ST EXT
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-6039
Practice Address - Country:US
Practice Address - Phone:518-725-8656
Practice Address - Fax:518-773-7824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150053207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty