Provider Demographics
NPI:1316906381
Name:MCCALL, BRADLEY T (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:T
Last Name:MCCALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:200 QUEENS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3252
Mailing Address - Country:US
Mailing Address - Phone:704-333-7376
Mailing Address - Fax:704-333-3397
Practice Address - Street 1:1021 MOREHEAD MEDICAL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2839
Practice Address - Country:US
Practice Address - Phone:704-355-2272
Practice Address - Fax:704-355-1865
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC385402085R0001X
SC189982085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2086570OtherUNITED HEALTHCARE
NC55628OtherBLUE CROSS
NC65238OtherMEDCOST
NC7380869008OtherCIGNA
NC26031OtherPARTNERS
NC8955628Medicaid
NC2221698Medicare ID - Type Unspecified
NC2221698FMedicare ID - Type UnspecifiedLAKE NORMAN RAD ONC CTR
SC920002206Medicare ID - Type UnspecifiedRAILROAD MEDICARE
SCF129766058Medicare ID - Type UnspecifiedSC MEDICARE
NC7380869008OtherCIGNA
NCF12976Medicare UPIN
NC2221698EMedicare ID - Type UnspecifiedMATTHEWS RAD ONC CTR
NC8955628Medicaid