Provider Demographics
NPI:1316918360
Name:MILLMAN, BRAD (MD)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:MILLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3624 MARKET STREET
Mailing Address - Street 2:SUITE 560W
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-662-3958
Mailing Address - Fax:
Practice Address - Street 1:777 TOWNSHIP LINE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067
Practice Address - Country:US
Practice Address - Phone:215-860-1775
Practice Address - Fax:215-860-7754
Is Sole Proprietor?:No
Enumeration Date:2006-01-29
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049066L207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015308800005Medicaid
PAG05715Medicare UPIN
PA775427Medicare ID - Type Unspecified