Individual
BRADLEY A BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18181 PEARL RD STE A102, STRONGSVILLE, OH 44136-6951
(440) 816-4250
Mailing address
PO BOX 638269, CINCINNATI, OH 45263-4455
(440) 816-4250
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
35053437
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221054
UNISON
OH
01
—
000000302578
ANTHEM
OH
01
—
000000511513
ANTHEM
OH
01
—
0304914
BCMH
OH
05
—
0629172
—
OH
01
—
4007005
AETNA
OH
01
—
414948
WELLCARE
OH
01
—
740475
BUCKEYE
OH
01
—
P00412281
RAILROAD MEDICARE
OH
Enumeration date
08/24/2005
Last updated
01/19/2021
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