Provider Demographics
NPI:1699761544
Name:BRADER, ERIC W (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:W
Last Name:BRADER
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 1:320 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:412-359-4138
Mailing Address - Fax:412-359-8874
Practice Address - Street 1:320 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-359-4138
Practice Address - Fax:412-359-8874
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031838E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000083384OtherUNISON
PA0012401820005Medicaid
PA567777JK6OtherPA MCR GROUP PTAN
PA930018789OtherRR MCR PIN
PA251034OtherUPMC
PA0016091200032OtherMEDICAID GROUP PIN
PA1513390OtherGATEWAY
PA0012401820005Medicaid
PA1513390OtherGATEWAY