Provider Demographics
NPI:1962615237
Name:BRADLEY, MARGOT (CRNP)
Entity type:Individual
Prefix:
First Name:MARGOT
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 WASHINGTON LANE
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1706
Mailing Address - Country:US
Mailing Address - Phone:215-884-1005
Mailing Address - Fax:
Practice Address - Street 1:101 N MERION AVE
Practice Address - Street 2:BRYN MAWR COLLEGE HEALTH CENTER
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010
Practice Address - Country:US
Practice Address - Phone:610-526-7360
Practice Address - Fax:610-526-7365
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP004215G363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health