Provider Demographics
NPI:1366433591
Name:SHOLLENBERGER, BRADLY SCOTT (DPM)
Entity type:Individual
Prefix:DR
First Name:BRADLY
Middle Name:SCOTT
Last Name:SHOLLENBERGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4885 DEMOSS RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-9023
Mailing Address - Country:US
Mailing Address - Phone:610-779-4020
Mailing Address - Fax:610-776-7044
Practice Address - Street 1:4885 DEMOSS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-9023
Practice Address - Country:US
Practice Address - Phone:610-779-4020
Practice Address - Fax:610-776-7044
Is Sole Proprietor?:No
Enumeration Date:2005-11-05
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002902L213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA31854OtherMERCY
PA688055OtherBLUE SHIELD
PA7990970OtherGATEWAY
PA0522660000OtherKHPE
PA01328801OtherBLUE CROSS
PA116509OtherMED PLUS
PA688055OtherKHPC
PA0020421000OtherKHPE
PA011820330007Medicaid
PA0020421000OtherKHPE
PA480012019Medicare ID - Type UnspecifiedRAILROAD MEDICARE
PA0000688055Medicare NSC
PA0522660000OtherKHPE
PA7990970OtherGATEWAY