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Individual
TIMOTHY ALBERT BRADLEY
Active
Individual
TIMOTHY ALBERT BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA061934
PA
363A00000X
Physician Assistant
OA006318
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1038405340004
—
PA
01
—
8N1168
MEDICARE
PA
Enumeration date
08/12/2019
Last updated
07/30/2026
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