Provider Demographics
NPI:1902979644
Name:BRADLEY, THOMAS PATRICK (MD, PHD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:PATRICK
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24571 SILVER CLOUD CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6583
Mailing Address - Country:US
Mailing Address - Phone:831-333-1719
Mailing Address - Fax:831-333-0442
Practice Address - Street 1:24571 SILVER CLOUD CT
Practice Address - Street 2:SUITE 201
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-6583
Practice Address - Country:US
Practice Address - Phone:831-333-1719
Practice Address - Fax:831-333-0442
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG075220207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI49731Medicare UPIN
CAAX507ZMedicare PIN